Earlier survivorship care linked to lower recurrence and death in head and neck cancer

Patients with head and neck cancer who began multidisciplinary survivorship care before or early in their radiotherapy had better survival and lower recurrence than patients who entered such care only after treatment, according to a University of Pittsburgh study published today in JAMA Otolaryngology–Head & Neck Surgery. The analysis of 471 patients, 148 of whom received early survivorship care, is among the first to link the timing of survivorship care — a factor the authors note can be modified relatively easily — with oncologic outcomes in this population.

Survivorship care provides long-term, multidisciplinary support for people with cancer, addressing mental and physical health, symptom management and monitoring for recurrence. Ideally it begins at diagnosis and continues for life, but in practice it is more commonly emphasized after treatment ends. “Survivorship care does vary across cancers, but generally, the standard is that all cancer survivors have access to survivorship resources after treatment,” said senior author Marci Lee Nilsen, Ph.D., R.N., professor of otolaryngology at Pitt’s School of Medicine and director of the UPMC Head & Neck Cancer Survivorship Clinic. “This study challenges that paradigm. I questioned why we intervene after symptoms and side effects have developed, when we could intervene earlier and hopefully prevent or mitigate them.”

At the UPMC Hillman survivorship clinic, patients see a multidisciplinary team — specialists in speech-language pathology, physical therapy, nutrition and dental care — in a single same-day visit that ends with a treatment summary and care plan shared with the patient, their oncology team and their primary care clinician. Nilsen’s team had previously shown that earlier survivorship care improved patients’ quality of life and psychological well-being; the new study asked whether earlier intervention could also improve the odds of surviving.

The researchers found that patients who participated in early survivorship care were about half as likely to miss or stop radiotherapy. Earlier care was also associated with a lower risk of recurrence and of death three years after treatment, even after adjusting for treatment adherence. That adjustment matters, the authors say, because it suggests the survival benefit is not solely explained by patients completing their prescribed radiotherapy. “I think a lot of times survivorship care is seen as just something that is nice to have but is not essential,” Nilsen said. “This study shows that if we just shift survivorship care a bit earlier, patients have better outcomes, better adherence to treatment. And even when you control for treatment adherence, you see an association between earlier care and survival.”

The findings are observational, drawn from a single institution’s clinic, and the researchers themselves caution that the association does not establish causation. To separate the effect of care timing from other aspects of cancer care, they propose a randomized controlled trial. Future studies will also examine how adjusting the timing of survivorship care affects cost and health care utilization. Still, the team argues that a relatively minor shift in when supportive services are delivered could have a meaningful impact on outcomes for a growing population of long-term survivors. “We have a growing population of cancer survivors who are being cured and living longer. But a cure is not the only endpoint for survivors,” Nilsen said. “They want to live the best life they can. Survivors will tell you how beneficial it has been for them having survivorship care support along that journey.”

Subject of Research: Timing of multidisciplinary survivorship care and oncologic outcomes in head and neck cancer patients treated with radiotherapy

Article Title: Earlier survivorship care linked to lower risk of head and neck cancer recurrence and death

Article References: Earlier survivorship care linked to lower risk of head and neck cancer recurrence and death. Original publication (Bibliographic details unavailable.)

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DOI: Not provided

Keywords: head and neck cancer, survivorship care, radiotherapy, treatment adherence, cancer recurrence, patient survival, multidisciplinary care, UPMC Hillman Cancer Center, observational study, JAMA Otolaryngology, supportive care, cancer survivors