Continuity of care: A program for multidisciplinary post-treatment surveillance after definitive treatment for head and neck cancer.

Abstract

82 Background: Patients with head and neck cancers (HNC) are treated with a combination of radiation therapy, chemotherapy, and surgery. With the epidemic of HPV-related oropharynx cancers, patients are younger and healthier; they will require routine surveillance and management of long-term toxicity for many years. There is little data on optimal follow-up and significant duplication of efforts with multiple appointments. Our goal was to create a multidisciplinary post-treatment surveillance program for patients with HNC treated with organ preservation to standardize their evaluation, decompress clinics, reduce duplication of testing, and improve patient satisfaction. Methods: A consensus schema to standardize follow-up was created, consistent with the institutional practice and NCCN guidelines. All services agreed to standardized testing with a rotation between the treating physicians for each follow-up. For the first year, testing occurred at 8 weeks and then every 3 months; for the second year, it occurred every 4 months. Deemed the Continuity of Care (COC) program, patients were identified at the time of tumor board, labeled as eligible at treatment initiation, and followed per its rules on completion. Results: A total of 360 new patients were identified that were eligible for follow-up on COC. In total, 237 (65%) of them had been treated at MD Anderson and reached or surpassed their 3 month follow-up visit. Of these, 209 patients (88%) were following the pathway. Overall, compliance with the pathway has been stable, and follow-up clinics have been streamlined for patients and providers. A 28% reduction in appointment duplications within 3 months of the past appointment has been measured. Conclusions: A model program for surveillance after treatment for HNC was designed and implemented. Patients enrolled had standardized testing and streamlined follow-up appointments during the first two years of surveillance, resulting in a significant decrease in appointment duplication. In addition, significant data was collected in this cohort, allowing for future studies of the optimal utilization of imaging, outcomes, and best practices for this growing group of patients.