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Timing and Reasons for Supportive Care Referral in Head and Neck Cancer: A Prospective Study From India
S Gayatri1, Anuja Damani1, Aswathi Praveen1
1Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Background:
Patients with head and neck cancer (HNC) receiving curative-intent radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) experience high symptom burden and acute treatment-related toxicities. Supportive Care (SC) can mitigate these effects; however, the timing and documented triggers for referral are insufficiently characterized in routine practice.
Methods:
We conducted a prospective, observational longitudinal cohort study (April 2023-March 2024) at a tertiary cancer center in India. Consecutive eligible adults with HNC receiving curative-intent RT/CCRT were enrolled (n = 96). Referral timing (days from RT initiation) and documented reasons were extracted from the electronic medical record (EMR). Symptom burden (ESAS-r [Edmonton Symptom Assessment Scale-Revised]), quality of life (FACT-HN), and toxicities (NCI CTCAE v5 [National Cancer Institute Common Terminology Criteria for Adverse Events Version 5]) were assessed at the first SC visit and at five follow-up visits over 8 weeks. Missing follow-up outcomes were imputed using the last observation carried forward (LOCF) method. Changes across visits were assessed using the Friedman test, with Kendall's W reported as an effect size.
Results:
The mean age was 56.35 years (SD 12.83); 70 (72.9%) were men. Half of the cohort lacked a documented referral reason in the EMR. Referrals occurred predominantly during the second and third treatment weeks (mean 19.2 days from RT initiation; SD 12.66; range 0-71 days). The timing of referral correlated strongly with the RT fractions received (Spearman's ρ = 0.942, p < 0.001). Pain improved from a median of 5 to 2 (χ2 = 141.68, p < 0.001; W = 0.30). Anxiety improved from a median of 3 to 2 (χ2 = 54.51, p < 0.001; W = 0.11). Total FACT-HN improved from a median of 83.7 to 96.7 (χ2 = 79.88, p < 0.001; W = 0.17).
Conclusions:
SC referrals for HNC patients are commonly reactive during peak acute toxicity periods rather than proactive. Structured referral triggers and improved EMR documentation may enhance timely symptom control and quality of life during curative treatment.
