A groundbreaking patient navigation program has demonstrated significant success in ensuring timely initiation of post-operative radiation therapy (PORT) for patients with head and neck squamous cell carcinoma (HNSCC), according to a randomized trial conducted at the Medical University of South Carolina (MUSC).
The Navigation for Disparities and Untimely Radiation ThErapy (NDURE) intervention showed remarkable improvements in treatment timing, with 74% of patients receiving timely PORT compared to 39% in the usual care group. The study included 176 adults with locally advanced HNSCC, with participants split evenly between the NDURE intervention and standard navigation care.
Critical Impact on Treatment Timing
The NDURE program achieved an average reduction of eight days in radiation therapy initiation time compared to usual care. This improvement is particularly significant as research indicates each week of delay beyond the recommended six-week window correlates with increased mortality rates.
"The goal of this research, in the long arc of things, is to change the standard of care for how patients with head and neck cancer are navigated, and how we deliver care that is coordinated, multidisciplinary and timely," explained Dr. Evan M. Graboyes, associate professor at MUSC.
Addressing Healthcare Disparities
Currently, approximately 50% of head and neck cancer patients experience delays in PORT initiation, with disproportionate impacts on racial and ethnic minorities, Medicaid recipients, and rural residents. The NDURE intervention successfully narrowed these gaps, effectively eliminating racial disparities in treatment delays between Black and white patients that persisted in the usual care group.
Comprehensive Intervention Components
The NDURE program encompasses several key elements:
- Patient education about timely PORT
- Screening for health-related social risks affecting treatment access
- Enhanced clinical documentation for improved team communication
- Active referral and appointment tracking by navigators
Expanding Implementation
The program's success has led to a National Cancer Institute-funded multi-center trial across four major institutions: Duke University, Baylor University, Washington University, and MUSC. This expanded study aims to validate the initial findings and explore implementation strategies across diverse healthcare settings.
The intervention's design prioritizes scalability, building upon existing navigator infrastructure in most cancer centers. "We chose navigation as the backbone of this intervention because most cancer centers already have navigators. It doesn't require a lot in terms of additional resources. It's just changing the way care is delivered," noted Dr. Graboyes.
Clinical Context and Significance
Unlike many other cancers, head and neck cancer lacks screening tests, resulting in most patients presenting with advanced disease requiring multiple treatment modalities. The timeliness of PORT initiation represents the only Commission on Cancer-approved quality metric for HNSCC, making the NDURE program's success particularly meaningful for improving patient outcomes.
The intervention's impact extends beyond immediate treatment timing, showing promise for broader applications in coordinating timely adjuvant therapy across various cancer types, including breast and colon cancers.
