Background: There are approximately 436,060 head and neck cancer (HNC) survivors living in the United States,1 and long-term survival is becoming more common in this population. The Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition, tells us that follow-up after completed cancer treatment is “critical to long-term health of cancer survivors.” Due to the nature of the disease and treatment modalities, HNC patients can have multiple health and wellness issues at the end of their treatment that remain unmet.2
Objectives: To improve the long-term survival and quality of life of our cancer patients by increasing the number of HNC patients scheduling a Survivorship visit during a 12-month pilot program.
Methods: The Head and Neck Clinic was identified as a partner in a pilot program to improve the number of patients scheduling a Survivorship visit.
Historically, patients were referred to the Survivorship program when their oncologist placed a referral in the hospital electronic medical record system (EPIC). The Survivorship scheduler then called to schedule the patient for a Survivorship visit. The following reasons were given when patients declined: They were not aware they had been referred to Survivorship, and they did not understand how they would benefit from a Survivorship visit. Based on these responses, we built our pilot program.
We needed to make the referral to Survivorship an integral part of the cancer care continuum. The transition from active treatment to survivorship needed to be seamless.
In 2020, the Barrett Cancer Center was building the nurse navigation team from 2 to 9 nurse navigators. Utilizing this resource would be essential to the success of our pilot.
The head and neck oncology nurse navigator (H& N ONN) would identify patients who were ready for transition from active treatment to survivorship and alert the Survivorship ONN.
At the next office visit the H& N ONN and the Survivorship ONN would meet the patient together. The H& N ONN would introduce the Survivorship ONN, who would then explain the Survivorship visit and how it benefits the patient.
The patient now understands the importance of this visit in relation to their ongoing oncology care, and a Survivorship visit was offered.
Results: In 2019, there were 110 HNC patients referred to Survivorship through the EPIC work queue. Of those 110 HNC patients, only 19 scheduled a Survivorship visit. In 2020, there were 55 HNC patients referred to Survivorship through the pilot program (during COVID, nonessential visits were prohibited). Of those 55 HNC patients, 30 scheduled a Survivorship visit. At the end of our 1-year pilot, the percentage of patients referred to Survivorship who scheduled an appointment increased from 17% in 2019 to 54% in 2020.
Conclusion: At the end of our pilot project, we met our objective by significantly increasing the number of patients scheduling a Survivorship visit. We are now implementing this process with other ONNs and their associated cancer specialties.
- Cohen EEW, LaMonte SJ, Erb NL, et al. American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA Cancer J Clin. 2016;66: 203-239.
- Giuliani M, McQuestion M, Jones J, et al. Prevalence and nature of survivorship needs in patients with head and neck cancer. Head Neck. 2016;38: 1097-1103.