Patient Reported Factors Influencing Decisions on Radiotherapy vs. Mohs Surgery for Non-Melanoma Skin Cancer of Cosmetically Challenging Head and Neck Sites at a Rural Radiation Satellite Facility

Abstract

<h3>Purpose/Objective(s)</h3> Regional satellite radiotherapy facilities of major academic cancer centers serve cancer patients in rural communities well by bringing high-quality radiation treatments closer to home. Non-melanoma skin cancer is one of the most common cancer types treated at our satellite facility in rural upstate New York. Here we report outcomes of a telephone questionnaire and investigate factors that influence patient decision making between surgery and radiation for post-biopsy treatment of Non-Melanoma Skin Cancers (NMSC) of the head and neck (H&N). We also report treatment outcomes after radiation therapy (RT) for NMSC in cosmetically challenging areas of H&N, at a rural RT facility of our academic medical center. <h3>Materials/Methods</h3> Patients with NMSC of the H&N that were deemedat risk for poor cosmetic outcome with traditional resection, have been given the option for RT or Mohs surgery. We identified 79 patients that elected to undergo RT at our rural clinic from 2017-2021. 47 patients completed an 8-question telephone survey. We asked: On a scale from 1 (unimportant) to 5 (very important), how much did the following factors: overall health, medication concerns, cosmetic outcomes, fear of pain, healing concern, transportation concern (distance to surgery vs. RT facility), prior history of NMSC, and prior surgical experience, influence your decision to have RT instead of Mohs surgery. The average distance from patient's primary residence to a Mohs surgeon and to the RT facility was measured using Google maps. <h3>Results</h3> The average age was 76 y/o with 77% male. There was a 70%/30% split between BCC and SCC. 91% were T1 stage, and all were Caucasian. A total of 62 sites were treated with 77%/23% being treated with orthovoltage vs. electrons. There was a local recurrence in 2 patients with a 96% LC rate over a 28m median follow up time. Physician reported cosmetic outcomes were satisfactory or excellent in 94% of cases, and 98% of patients reported satisfaction with their treatment. Concerns about transportation, overall health, and cosmetic outcomes were the top 3 factors in choosing RT over surgery, with average scores of 4.47, 3.30, and 2.91 respectively (1-5 scale). The average distance for patients to RT facility vs. a Mohs surgeon was significantly shorter, 9.7 miles vs. 32.6 miles (p<0.05). <h3>Conclusion</h3> Our experience with RT for H&N NMSC treated at our rural satellite facility shows excellent local control, cosmetic outcomes, and patient satisfaction. While Mohs surgery remains one of the preferred options for managing cosmetically challenging NMSC, many patients still prefer RT. In our rural, elderly cohort, we have identified that concerns about transportation is the primary factor for patients electing to undergo RT over surgery.