Delays to Post-Operative Radiotherapy in Patients With Head and Neck Squamous Cell Carcinoma: A Mixed-Methods...

Post-operative radiation therapy (PORT) delays are associated with reduced survival and higher recurrence rates in patients with head and neck squamous cell carcinoma (HNSCC). This study explores health worker perspectives on barriers and solutions to timely PORT in an Australian regional centre with a large Aboriginal and Torres Strait Islander population.

This paper incorporated an explanatory sequential mixed methods design. Head and neck multidisciplinary team (HNMDT) members involved in the care of patients with HNSCC at a regional tertiary centre were invited to participate. Participants completed an online survey and underwent semi-structured focus groups/interviews.

Nineteen healthcare workers participated in the surveys. The three factors most attributed to PORT delays were rurality, surgery at an external facility and Indigenous status. Ten healthcare workers subsequently participated in focus groups/interviews. Three themes regarding solutions to PORT delays were identified: addressing care fragmentation, improving care coordination and ensuring cultural safety in Aboriginal and Torres Strait Islander care. Strategies proposed to address care fragmentation included streamlining referral pathways, utilising electronic reminders for clinicians and coordinators to prompt follow-up, and increasing local service provision. Solutions suggested to improve care coordination included flagging patients early for follow-up, timely organisation of transport and accommodation, and employing head and neck-specific cancer care coordinators. Strategies proposed to ensure cultural safety included instituting cultural immersion programmes, promoting earlier Indigenous Liaison Officer engagement, supporting family involvement, and developing culturally appropriate patient resources.

This study highlights barriers and solutions to timely PORT in an Australian regional centre with a large Aboriginal and Torres Strait Islander population. Strategies aimed at the patient and systems level and formed in partnership with Indigenous peoples must be instituted to address delays.