Barriers to follow-up and rehabilitation among head and neck cancer survivors in Norway: A qualitative study.

Abstract

Purpose: The aim was to explore head and neck cancer (HNC) survivors' experiences of barriers to follow-up care and rehabilitation in Norway 3-5 years after treatment.

Methods: This descriptive qualitative study involved 12 individual interviews with Norwegian HNC survivors. Data were analysed using inductive semantic thematic analysis. Haggerty's continuity-of-care framework subsequently informed the interpretation of findings in relation to informational continuity (the use of information to connect care), relational continuity (ongoing patient-provider relationships), and management continuity (coordinated and consistent care across providers).

Results: Four themes emerged: (1) limited continuity due to difficult access to services and frequent personnel changes, leading to fragmented care and insufficient follow-up; (2) challenges in information flow and communication, including complex and poorly tailored information, speech barriers, and increasing reliance on self-management; (3) inadequate coordination across care levels, with unclear responsibilities and limited collaboration, particularly during transitions to primary care; and (4) structural barriers affecting access, including limited availability of specialised services, financial burden, and challenges navigating digital systems.

Conclusion: HNC survivors face substantial barriers to continuity in follow-up and rehabilitation, which may be particularly pronounced in rural areas. Targeted strategies to improve coordination, accessibility, and integration within and across healthcare services are needed to promote equitable, holistic, and long-term support for survivors with complex needs.