Improving timing and sequencing of postoperative radiation therapy in head and neck cancer

The Commission on Cancer recognizes the importance of timing and sequencing care to improve the quality of health care delivery and cancer outcomes. In 2021, the Commission on Cancer established a quality metric for head and neck cancer to achieve postoperative radiation therapy within 6 weeks of surgery. The 4R Oncology Model is a teams-based framework that accounts for interdependency of care and allows for sustainable multilevel quality improvement in multiple other cancer types. We demonstrate the development of a 4R quality improvement framework to achieve this new Commission on Cancer standard for head and neck cancers within a community oncology program.

A multidisciplinary team was formed to map out care processes to develop the 4R care plan. Electronic medical record abstraction led to the development of baseline data. A patient dashboard was coded within the electronic medical record to enable tracking major elements of care. Formal Plan-Do-Study-Act methodology has been deployed to start a first test of change in 2026.

A single-page 4R care plan was developed that depicts critical and interdependent guideline-based elements to help patients/family and the care team proceed from surgery to postoperative radiation therapy. Baseline data showed that 61% of patients started postoperative radiation therapy within 6 weeks of surgery, and a goal was set for 80% of patients to reach the Commission on Cancer quality metric by the end of 2026. The 4R model revealed dental work, in certain centers, and speech therapy referrals as the primary quality improvement efforts needed in the program.

The 4R oncology model is a feasible framework to help identify interdependent care steps and demonstrate areas of prioritization for quality improvement, which could ultimately lead to implementation of Commission on Cancer quality goals that rely on timing and sequencing of interdependent care.