Impact of Presurgical Second-Touch Visits on Delays in Initiating Adjuvant Radiation Therapy.

Abstract

Objective: 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.

Study design: Retrospective cohort study.

Setting: Single tertiary referral center.

Methods: 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.

Results: 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).

Conclusion: 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.