Ohlstein Jason F, Brody-Camp Sabrina, Friedman Starr, Levy Joshua M, Buell Joseph F, Friedlander Paul
Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana.
Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
JAMA Otolaryngol Head Neck Surg. 2015 Sep;141(9):804-9. doi: 10.1001/jamaoto.2015.1467.
Specific temporal goals for treatment of head and neck cancer (HNC) are common in Europe but not in the United States. We implemented a patient-centric navigation model with an aspirational goal that all patients will receive treatment recommendations within 2 weeks of presentation as a means to improve outcomes in our patients with HNC.
To assess the temporal impact of using an aspirational goal in a patient-centric navigation system on the time from presentation to formulation of treatment planning for patients with HNC.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of 100 consecutive patients treated for squamous cell carcinoma of the head and neck at a tertiary referral center between 2011 and 2014. Patients were assessed to determine the efficiency of a patient-centric navigational model in delivering cancer treatment recommendations. This model was designed with an aspirational goal of providing treatment recommendations within a 2-week period.
Starting in 2011, patient-centric navigation model including the assignment of a nurse who acts as a patient navigator.
The time interval between presentation to clinic and definitive treatment recommendations, as well as factors associated with delay.
Of the 93 patients who met inclusion requirements, most were white (81 [87%]) males (74 [80%]) with a mean (SD) age of 63.4 (10.8) years insured by Medicare or Medicaid (64 [69%]). Forty-seven (51%) received treatment recommendations within the 2-week period, with median and mode values of 15 and 14 days, respectively. The mean (SD) interval was 18.8 (18.6) days. Outliers included 2 patients with synchronous lung nodules (72 and 85 days) and 2 patients with psychosocial barriers (107 and 86 days). There were no significant differences seen for the mean (SD) time interval with respect to patient race (blacks, 17.6 [15.7] vs whites, 22.5 [30.0]; P = .20), sex (males, 18.3 [18.1] vs females, 20.4 [19.7]; P = .13), insurance status (insured, 16.3 [10.2] vs uninsured, 19.8 [21.0]; P = .24), and stage at presentation (stage I, 14.4 [17.0] vs stage II, 11.0 [5.3] vs stage III, 14.7 [8.6] vs stage IV, 21.2 [20.2]; P = .40).
The goal of treatment recommendations for HNC within 2 weeks was shown to be reasonable and attainable. Further research should address the delays encountered by patients with psychosocial barriers and those with synchronous lung nodules.
在欧洲，头颈部癌（HNC）治疗的特定时间目标很常见，但在美国并非如此。我们实施了一种以患者为中心的导航模式，设定了一个理想目标，即所有患者在就诊后2周内都能收到治疗建议，以此作为改善我们HNC患者治疗效果的一种手段。
评估在以患者为中心的导航系统中使用理想目标对HNC患者从就诊到制定治疗计划的时间的影响。
设计、设置和参与者：对2011年至2014年期间在一家三级转诊中心接受头颈部鳞状细胞癌治疗的100例连续患者进行回顾性研究。评估患者以确定以患者为中心的导航模式在提供癌症治疗建议方面的效率。该模式设计的理想目标是在2周内提供治疗建议。
从2011年开始，采用以患者为中心的导航模式，包括指定一名护士作为患者导航员。
从就诊到明确治疗建议的时间间隔，以及与延迟相关的因素。
在符合纳入要求的93例患者中，大多数是白人（81例[87%]）男性（74例[80%]），平均（标准差）年龄为63.4（10.8）岁，由医疗保险或医疗补助承保（64例[69%]）。47例（51%）在2周内收到治疗建议，中位数和众数分别为15天和14天。平均（标准差）间隔为18.8（18.6）天。异常值包括2例有同步性肺结节的患者（72天和85天）和2例有社会心理障碍的患者（107天和86天）。在平均（标准差）时间间隔方面，患者种族（黑人，17.6[15.7]天对白人，22.5[30.0]天；P = 0.20）、性别（男性，18.3[18.1]天对女性，20.4[19.7]天；P = 0.13）、保险状况（参保，16.3[10.2]天对未参保，19.8[21.0]天；P = 0.24）以及就诊时的分期（I期，14.4[17.0]天对II期，11.0[5.3]天对III期，14.7[8.6]天对IV期，21.2[20.2]天；P = 0.40）均无显著差异。
HNC在2周内给出治疗建议的目标被证明是合理且可实现的。进一步的研究应关注有社会心理障碍的患者以及有同步性肺结节的患者所遇到的延迟问题。
