Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, Australia.
ENT Department, The Queen Elizabeth Hospital, Woodville, 5011, Australia.
Eur Arch Otorhinolaryngol. 2024 Nov;281(11):5923-5930. doi: 10.1007/s00405-024-08791-x. Epub 2024 Jul 10.
Service delivery of post-treatment surveillance in head and neck cancer (HNC) varies across institutions in Australia. To better understand current practices and develop protocols that maximize service capacity or incorporate emerging technologies, especially in under-resourced regional and remote communities, it is important to obtain the perspectives of clinicians that regularly manage patients with HNC.
This cross-sectional study utilized an online survey distributed via email to specialists recruited from HNC-associated networks across Australia. The survey captured information on current practices and explored clinician perspectives towards re-designing the current surveillance model to incorporate telehealth or patient-reported outcome measures (PROMs). Quantitative data was analyzed using descriptive statistics while open-ended survey comments were analyzed using a content analysis approach.
Forty participants completed the survey (25 surgeons, 9 medical oncologists, 5 radiation oncologists and 1 oral medicine specialist). Most clinicians used either institution-specific guidelines (44%) or National Comprehensive Cancer Network guidelines (39%), with the remaining 17% using surveillance intervals based on patient symptoms. Following treatment, 53% of participants imaged patients only when there was clinical suspicion of recurrence or new symptoms. Planned surveillance imaging was conducted at 6 or 12-monthly intervals based on the HNC subtype. Fifty-seven percent of clinicians were open to redesigning the surveillance model, specifically in low-risk patients who did not require nasoendoscopic examination. Seventy-one percent had concerns regarding the feasibility of telehealth appointments, citing disparities in digital health equity. Additionally, 61% felt PROMs are currently underutilized and were open to incorporating HNC-specific PROMS into surveillance. Open-ended responses indicated that within the current surveillance model, "fragmented service provision" and "administration issues" were significantly impacting on timing of care.
Surveyed HNC clinicians feel that current post-treatment surveillance can be fragmented and potentially lead to delayed care. They are open to incorporating PROMS to assist in surveillance scheduling, especially in low-risk patients.
澳大利亚各机构在头颈部癌症（HNC）治疗后监测的服务提供情况各不相同。为了更好地了解当前的实践情况，并制定最大限度地提高服务能力或纳入新兴技术的方案，特别是在资源不足的区域和偏远社区，了解定期管理 HNC 患者的临床医生的观点很重要。
本横断面研究通过电子邮件向澳大利亚 HNC 相关网络招募的专家发送在线调查，利用该调查获取当前实践信息，并探讨临床医生对重新设计当前监测模型以纳入远程医疗或患者报告结果测量（PROMs）的看法。使用描述性统计分析定量数据，而对开放式调查评论则使用内容分析方法进行分析。
40 名参与者完成了调查（25 名外科医生、9 名肿瘤内科医生、5 名放射肿瘤医生和 1 名口腔医学专家）。大多数临床医生使用机构特定指南（44%）或国家综合癌症网络指南（39%），其余 17%根据患者症状使用监测间隔。治疗后，53%的参与者仅在临床怀疑复发或出现新症状时才对患者进行影像学检查。基于 HNC 亚型，计划的监测影像学检查在 6 或 12 个月进行一次。57%的临床医生愿意重新设计监测模式，特别是对于不需要鼻内窥镜检查的低风险患者。71%的人对远程医疗预约的可行性表示担忧，理由是数字健康公平存在差异。此外，61%的人认为 PROMs 当前未得到充分利用，并愿意将 HNC 特定的 PROMS 纳入监测。开放性回答表明，在当前的监测模式中，“分散的服务提供”和“管理问题”严重影响了护理的时间安排。
调查的 HNC 临床医生认为，当前的治疗后监测可能会出现碎片化，并可能导致护理延迟。他们愿意纳入 PROM 以协助监测安排，特别是对于低风险患者。
