Geographic Barriers Affect Follow‐Up Care in Head and Neck Cancer. (11th November 2021)

• Record Type: Journal Article
• Authors: Alwani, Tooba; Shehan, Jennifer N.; LeClair, Jessica; Mahoney, Taylor F.; Agarwal, Pratima; Chaudhry, Salil T.; Wang, Judy J.; Noordzij, Jacob P.; Tracy, Lauren F.; Edwards, Heather A.; Grillone, Gregory; Salama, Andrew R.; Jalisi, Scharukh M.; Devaiah, Anand K.
• Is Part Of: Laryngoscope. Volume 132:Number 5(2022)
• Page Start: 1022
• Page End: 1028
• Publication Date: 2021-11-11
• Subjects: Head and neck cancer -- socioeconomic -- social determinants of health -- healthcare disparities -- follow‐up care -- follow‐up -- geographic -- zip code; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.29934
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives/Hypothesis: Follow‐up care in head and neck cancers (HNC) is critical in managing patient health. However, social determinants of health (SDOH) can create difficulties in maintaining follow‐up care. The study goal is to explore how SDOH impacts maintenance of HNC follow‐up care appointments. Methods: A systematic retrospective chart review of 877 HNC patients diagnosed in the past 10 years a safety‐net tertiary care hospital with systems to help reduce care disparities. Cohort groups were identified and compared against protocols for follow‐up. Data were analyzed using analysis of variance, chi‐square tests, Fisher's exact tests, two‐sample t ‐tests, and simple linear regression. Results: The average length of follow‐up time in months and average total number of follow‐ups over 5 years were 32.96 (34.60) and 9.24 (7.87), respectively. There was no significant difference in follow‐up care between United States (US) versus non‐US born and English versus non‐English speaking patients. Race/ethnicity, county median household income, insurance status, and county educational attainment were not associated with differences in follow‐up. However, living a greater distance from the hospital was associated with lower follow‐up length and less frequency in follow‐up ( P < .0001). Conclusion: While income, primary language, country of birth, race/ethnicity, insurance status, and markers of educational attainment do not appear to impact HNC follow‐up at our safety‐net, tertiary care institution, and distance from hospital remains an important contributor to disparities in care. This study shows that many barriers to care can be addressed in a model that addresses SDOH, but there are barriers that still require additional systems and resources. Laryngoscope, 132:1022–1028, 2022