The Impact of Head and Neck Multidisciplinary Clinic on Treatment Package Time During the COVID-19 Pandemic: A Single Institutional Experience

Abstract

Purpose/Objective(s)The onset of the COVID-19 pandemic in the United States has had a profound impact on the delivery of medical care in this country, particularly in the outpatient clinical setting. A result of the pandemic has been the introduction of delays in the diagnosis and treatment of head and neck cancer which are strongly associated with inferior oncologic outcomes. Efforts to minimize these delays are therefore a high priority in this patient population. Here, we report the results from one particular intervention taken at our institution - the formation of a multidisciplinary clinic (MDC) - on treatment times.Materials/MethodsIn July 2020, our institution initiated a pilot program establishing a MDC combining otolaryngology and radiation oncology visits. Clinics were held on a half-day every two weeks and consisted of both new patient consults and follow-up patients who had received radiation as part of their treatment course. We measured and compared treatment package time of the MDC patients with those seen at our institution in the standard clinic setting.ResultsA total of 25 new patients requiring radiation were seen in our MDC between 7/31/2020 and 9/3/2021. This included 8 patients who underwent definitive radiation, 12 patients who underwent adjuvant radiation, and 5 patients who underwent palliative radiation. A total of 54 patients received radiation through standard clinics during this time frame, with 21 definitive cases, 28 adjuvant cases, and 5 palliative cases. There was no difference in median radiotherapy duration between the patients seen in MDC vs standard clinics (41 vs 41 days, p = NS). In comparison, however, the patients seen in MDC started adjuvant radiotherapy sooner (median 34 vs 41.5 days, p=0.002) and had a more compact treatment package times (median 76.5 vs 84.5 days, p=0.002). Three patients in the standard clinics cohort had treatment package times exceeding 100 days while no patient seen in MDC had a treatment package time exceeding 84 days.ConclusionDespite the many challenges associated with the ongoing COVID-19 pandemic, we found that patients seen in our MDC setting maintained timely treatment package times that were significantly better than those seen in our standard clinics. This is potentially due to the identification of patients likely to require adjuvant radiotherapy earlier in their clinical presentation. This in turn allowed for more advanced planning and minimization of delays in initiation of adjuvant radiotherapy. While previous studies have demonstrated improved oncologic outcomes when head and neck multispecialty care is delivered at tertiary care facilities, we found a further improvement in care delivery with colocalization of clinic visits by the treatment team.