Community Health Support for Emergency Department-Presenting Head and Neck Cancer Patients: A Pilot to Improve Access to Timely Care

This is a single-arm, prospective pilot study evaluating the feasibility and process impact of embedding Community Health Support Specialist (CHSS) navigation within the emergency department (ED)-to-treatment pathway for newly suspected or newly diagnosed head and neck cancer (HNC) patients. The study will be conducted at three UTHSC-affiliated hospitals: Methodist University Hospital and Regional One Health.

Eligible participants are adults aged 18 years or older who present to the ED with a new or suspected HNC involving the oral cavity, oropharynx, hypopharynx, larynx, salivary glands, skin, sinonasal region, nasopharynx, thyroid, or an unknown primary. Patients who have already established oncology care, are in hospice, incarcerated, or cannot be contacted by phone will be excluded.

After screening and verbal consent, CHSS specialists will initiate contact with each participant within 72 hours of ED discharge. The CHSS will provide structured, non-clinical support through at least two phone or text contacts before the start of definitive cancer treatment. Each contact will document barriers, interventions, and resolution status using standardized REDCap case report forms. Typical support activities include arranging transportation referrals, assisting with insurance verification or enrollment, connecting patients to housing or community resources, and reinforcing communication between patients and provider offices. CHSS staff will not provide clinical advice, make appointments, or alter treatment plans.

The primary outcomes are (1) the interval from ED presentation to diagnostic biopsy and (2) the interval from ED presentation to initiation of definitive treatment. Secondary outcomes include feasibility, measured as the proportion of enrolled participants completing CHSS navigation. Exploratory outcomes describe types of social barriers identified, barriers resolved, and overall navigation patterns.

Data will be entered and stored in REDCap, a secure, HIPAA-compliant database hosted by the University of Tennessee Health Science Center (UTHSC). Analyses will compare outcomes for the pilot cohort with a historical control group of similar ED-presenting HNC patients treated at UTHSC-affiliated hospitals in the 24 months preceding implementation. Non-parametric and regression analyses will estimate effect sizes and feasibility parameters to guide future multi-site implementation studies.