Bon-Nieves Antonio A, Wang Naomi C, Wagoner Sarah F, Alapati Rahul, Feucht Maria, Ramesh Uma, Nallani Rohit, Rea Emma, Sommer Colleen, Lawrence Amelia S, Sykes Kevin J, Kakarala Kiran, Shnayder Yelizaveta, Bur Andrés M, Hamill Chelsea S
University of Kansas Medical Center, Kansas City, Kansas, USA.
Baylor Scott and White Health and Wellness Center, Dallas, Texas, USA.
Otolaryngol Head Neck Surg. 2025 Jun;172(6):1980-1987. doi: 10.1002/ohn.1194. Epub 2025 Apr 10.
Patients with head and neck squamous cell carcinoma (HNSCC) often encounter delays in starting postoperative radiotherapy (PORT), leading to worse outcomes. We investigated whether attending second-touch visits-appointments after the initial clinic visit and before surgery to address treatment-related questions and follow-up expectations-with an advanced practice provider (APP) is associated with reduced PORT delays.
Retrospective cohort study.
Single tertiary referral center.
Adult patients with HNSCC who underwent free flap surgery and PORT between 2020 and 2022 were included. All patients were offered a second-touch visit. The primary outcome was PORT delay, defined as treatment initiation >42 days after surgery. Clinicodemographic and treatment-related data were collected at baseline and at the last known follow-up.
Of the 104 patients included, 57.7% attended a second-touch visit. Attendance was associated with receiving radiotherapy (RT) in an academic setting (65.0% vs 40.9%, P = .015) and fewer PORT delays (56.7% vs 79.5%, P = .015). Multivariable analysis revealed a 70% reduction in odds of PORT delay for those attending second-touch visits (adjusted odds ratio [aOR] = 0.298, 95% CI 0.103-0.866, P = .026). PORT delay was more likely in patients with RT in a community setting (aOR = 3.783, 95% CI 1.284-11.146, P = .016), wound complications (aOR = 5.149, 95% CI 1.363-19.460, P = .016), and a higher comorbidity index (aOR = 1.407, 95% CI 1.012-1.957, P = .042).
Attendance of a second-touch visit and RT at a tertiary medical center significantly reduced the likelihood of PORT delay. These findings underscore the importance of APP-driven patient navigation in improving timely care and outcomes for patients with HNSCC.
头颈部鳞状细胞癌（HNSCC）患者术后放疗（PORT）开始时间常常延迟，导致预后更差。我们调查了在初次门诊就诊后、手术前与高级执业医师（APP）进行二次接触就诊（预约以解决与治疗相关的问题和随访期望）是否与减少PORT延迟相关。
回顾性队列研究。
单一的三级转诊中心。
纳入2020年至2022年间接受游离皮瓣手术和PORT的成年HNSCC患者。所有患者均获得二次接触就诊机会。主要结局为PORT延迟，定义为手术后>42天开始治疗。在基线和最后一次已知随访时收集临床人口统计学和治疗相关数据。
纳入的104例患者中，57.7%参加了二次接触就诊。参加二次接触就诊与在学术环境中接受放疗（RT）相关（65.0%对40.9%，P = 0.015），且PORT延迟较少（56.7%对79.5%，P = 0.015）。多变量分析显示，参加二次接触就诊的患者PORT延迟几率降低70%（调整后的优势比[aOR]=0.298，95%置信区间0.103 - 0.866，P = 0.026）。在社区环境中接受RT的患者（aOR = 3.783，95%置信区间1.284 - 11.146，P = 0.016）、有伤口并发症的患者（aOR = 5.149，95%置信区间1.363 - 19.460，P = 0.016）以及合并症指数较高的患者（aOR = 1.407，95%置信区间1.012 - 1.957，P = 0.042）发生PORT延迟的可能性更大。
在三级医疗中心参加二次接触就诊和接受RT可显著降低PORT延迟的可能性。这些发现强调了APP驱动的患者导航在改善HNSCC患者及时治疗和预后方面的重要性。
