Cancer survivorship care among head and neck cancer patients living in rural and urban locations.

Abstract

Purpose: National Standards for Cancer Survivorship Care (i.e., survivorship standards) were developed as policy, process, and assessment standards to guide quality of survivorship care across all cancer settings. This descriptive study uses two methods to provide a picture of the alignment of care for patients with head and neck cancer (HNC) with survivorship standards in an academic health care system in Southeast Texas.

Methods: One method consisted of an anonymous survey of 15 HNC providers' perceptions of alignment of survivorship standards with HNC. A modified kappa score for each standard was computed as proportion of participants' agreement that the standard was relevant to the institutions' HNC care. Scores ranged from 1 (highly relevant) to 0 (not relevant). The second method analyzed encounters over a 1-year period after diagnosis using electronic health record (EHR) data of 438 patients with HNC from the same institution. Statistical analysis included descriptive statistics and generalized linear models.

Results: Modified kappa scores showed the institution's processes to provide HNC survivorship services were more aligned with survivorship standards (process = 0.60) than institutional policies or assessments (policies = 0.28; assessments = 0.29). EHR data analysis found HNC survivorship services consisted of nearly ¼ of encounters but concentrated in specialist and rehabilitation survivorship care.

Conclusion: The study's cross-cutting themes include need for policies and assessments that increase EHR documentation of HNC survivorship care.

Implications for cancer survivors: The survivorship standards may be useful in developing clinical and informatics infrastructure needed to advance the quality of HNC survivorship care.