Evaluating Postoperative Radiotherapy Pathways for Head and Neck Cancer Patients in a Regional Hospital in Australia.

Abstract

Introduction: Timely initiation of postoperative radiotherapy (PORT) is critical in head and neck cancer, with delays exceeding 42 days associated with inferior outcomes. However, delays remain common, particularly in regional settings. This study aimed to evaluate targeted quality improvement (QI) interventions on PORT timeliness in a regional Australian tertiary hospital.

Methods: A single-centre QI study was conducted at Townsville University Hospital. Five interventions targeting referrals, multidisciplinary coordination, and radiotherapy workflow were implemented. Serial audits were performed six-monthly for three cycles and compared with pre-intervention. The primary outcome was time from surgery to PORT and the proportion of patients exceeding 42 days. Secondary outcomes included key interval analyses across the treatment pathway.

Results: A total of 78 patients were included (28 pre-intervention and 50 post-intervention). The QI interventions were associated with a 23 percentage-point absolute risk reduction in PORT delay (95% CI 2-42; p = 0.046). Median time to PORT decreased from 50 days pre-intervention to 42 days. Improvements were driven by reductions in early pathway delays, with surgery to radiation oncology (RO) consultation decreasing from 27 to 20.5 days. Timeliness of RO referrals for externally operated patients also improved (31 to 10 days). However, the interval from RO consult to PORT remained largely unchanged.

Conclusion: This QI project improved early pathway efficiency and reduced extreme delays in PORT. However, the persisting interval between RO consult and PORT likely reflects underlying radiotherapy delivery capacity constraints. Future work should focus on scheduling, resource allocation, and workforce capacity to further improve timeliness to PORT.