2172 - Improved Treatment Package Times with Head and Neck Multidisciplinary Clinic Care in Patients with High-Risk Socioeconomic Features

C. T. Wilke¹, and S. Khaja²; ¹Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, ²Department of Otolaryngology, University of Minnesota, Minneapolis, MN

Purpose/Objective(s): In July 2020, we initiated a pilot program establishing a multidisciplinary clinic (MDC) combining otolaryngology and radiation oncology appointments for patients diagnosed with head and neck cancer. We have previously reported initial findings from our first two years of MDC demonstrating substantially improved treatment package times (TPTs) for our MDC patients receiving adjuvant therapy compared to patients receiving care through the conventional clinic and satellite locations at our institution. Here, we present additional follow-up data along with the inclusion of sociodemographic features for patients seen in our MDC, conventional and satellite clinics to identify significant predictors for prolongation of TPTs. Materials/

Methods: We conducted a retrospective review of patients receiving care through our MDC, conventional clinic or satellite clinic locations for head and neck cancer between 7/31/2020 - 2/1/2023. Patients were included if they received curative-intent surgical resection of a head and neck cancer followed by adjuvant radiotherapy +/- chemotherapy. Clinical and sociodemographic data for all patients was collected and stratified by clinic location.
Results: We identified a total of 141 patients who received adjuvant radiotherapy (MDC: 32; conventional: 86; satellite: 23) through our institution. A total of 3 patients treated at the satellite clinics discontinued adjuvant radiotherapy early while one patient seen in the conventional clinic died before the completion of therapy. Similar to our initial analysis, we observed significantly improved TPTs in the MDC vs conventional vs satellite clinic patients (median: 78 vs 84 vs 90 days, p<0.001) within this larger cohort. When evaluating demographic characteristics, MDC had a greater proportion of patients self-identifying as BIPOC vs conventional or satellite clinic locations (19 vs 8 vs 5%). MDC patients also trended towards living in rural (25 vs 22 vs 11%, p=0.4) and medically underserved communities (77 vs 59 vs 68%, p=0.4). When evaluating interplay between TPTs and social determinants of health, a significantly greater percentage of BIPOC (100 vs 71 vs 0%, p=0.05) and rural (88 vs 47 vs 0%, p=0.02) had TPTs =85 days with MDC vs conventional or satellite clinics. Subsequent multivariate analysis including race, income and geographic factors revealed MDC as the only significant predictor of TPTs <85 days.
Conclusion: We observed a continued improvement in TPTs following initiation of a MDC at our institution that persisted on longitudinal follow-up. Compared to the conventional and satellite clinic locations, a greater percentage of patients seen in MDC had significant socioeconomic risk factors commonly associated with delays in cancer care. These patients maintained excellent TPTs in MDC compared to other clinic settings supporting the advantages of multispecialty expertise and improved efficiency in care delivery under this model.