Understanding Disparities to Follow-Up Care in Head and Neck Cancer (2024-2025)

Background

Racial and ethnic gaps in head and neck cancer (HNC) outcomes have been well documented. Among all cancers, HNC ranks third worst in the gap between Black and white patients’ five-year survival rates. In addition to this concerning mortality divide, access to care remains an issue for marginalized groups, resulting in reduced engagement with cancer healthcare services. Studies reveal that individuals from racial and ethnic minorities are less likely to make use of recommended HNC follow-up services outlined by the National Comprehensive Cancer Network guidelines.

Ensuring follow-up care in HNC is pivotal for enhancing quality of life and reducing overall mortality rates. However, patients from racial and ethnic minority backgrounds, especially Black and Hispanic patients, often face impediments accessing follow-up care due to issues such as geographic distance from healthcare facilities, socioeconomic status and language preference. Moreover, evidence suggests that HNC patients experiencing greater social vulnerability are less likely to receive necessary care. 

The precise role of social determinants of health in causing delays in healthcare utilization among HNC patients remains uncertain. However, it is critical to investigate and address these disparities in HNC healthcare, as minority patients who miss follow-up appointments face heightened risks of adverse health outcomes. Public health initiatives aimed at enhancing the use of follow-up services among racial and ethnic minority HNC patients are indispensable in eradicating healthcare disparities.

Project Description

This project team will evaluate the association of social determinants of health with racial and ethnic disparities in follow-up care for HNC patients, with three primary aims: 

  1. Understand factors associated with disparities in utilization of HNC follow-up care. Team members will retrospectively investigate rates of missed follow-up care appointments among HNC patients and assess disparities and associations with follow-up care underutilization. Prospectively, team members will administer validated survey evaluating access to care among patient populations who receive HNC treatment at Duke University Hospital. 
  2. Describe the social needs of the head and neck cancer patient population. Team members will use a validated survey to screen for social need among HNC patients who present to clinic visit. All patients meeting inclusion criteria will receive a handout of community resources. Team will work with a qualitative expert to design and conduct interviews to aimed to understanding unmet social need, access to care and post-treatment needs for HNC patients. 
  3. Evaluate post-treatment telephone follow-up in assessing HNC patient recovery and access to care. Post-treatment, team members will perform phone calls to identify post-treatment needs and barriers to follow-up care. For patients who fail to attend one or more follow-up services after completion of radiation treatment, team members will examine patient reasons for missing appointments and connect patients with social need to community resources.

Anticipated Outputs

Abstracts for poster and oral presentations; publications; grant proposals; development of equity-based service intervention

Student Opportunities

Ideally, this project team will include 2-3 graduate students and 2-3 undergraduate students interested in community engagement, public health, social determinants of health, and achieving health equity. Student with prior experience in health disparities research and developing health equity projects is preferred, but not required. Prior experience with qualitative research design and analysis is a plus.

Undergraduate students should be interested in medical research, social determinants of health, and improving access to care. Majors of interest include public policy, sociology, medical sociology, and global health. Proficiency in Microsoft Word, Excel, and Powerpoint is recommended for team members.

Graduate students will be strong candidates for team leaders and will be expected to use their expertise to help optimize team engagement with clinical research and development. Graduate students will have the opportunity to build leadership and mentorship skills.

All team members will deepen their knowledge about how social determinants of health impact access to healthcare. The team will conduct a literature review that identifies barriers to HNC follow-up care, develop a telephone follow-up program for HNC patients, screen HNC patients for social need, and design and transcribe patient interviews. They will also help gather community resources to connect with patients who experience social need. Team members will gain a better understanding of health disparities research and learn how to design and evaluate health equity-driven initiatives. 

This team will meet on Wednesdays from 1:00-2:00pm.

Team members will have the opportunity to begin work in the summer of 2024. Ideally, students will work for six weeks for about five hours a week. Students will focus on conducting a literature review and developing research strategy and will work remotely.

Rebecca Zasloff will serve as the project manager.

Timing

Summer 2024 – Spring 2025

  • Summer 2024 (optional): Create literature reviews of disparities and barriers to follow-up care among HNC patients; finalize research strategy and survey tools.
  • Fall 2024: Start data collection (enroll patients in study, distribute patient surveys, conduct interviews, begin chart review, conduct telephone follow-up initiative)
  • Spring 2025: Analyze data; prepare summary of project outcomes; submit research project and findings for publication

Crediting

Academic credit available for fall and spring semesters; summer funding available

Neck.

Team Leaders

  • Nosayaba Osazuwa-Peters, School of Medicine-Head and Neck Surgery and Communication Sciences
  • Tammara Watts, School of Medicine-Head and Neck Surgery and Communication Sciences
  • Rebecca Zasloff, School of Medicine–MD Student

/yfaculty/staff Team Members

  • Laura Fish, School of Medicine-Prevention Research
  • Pooja Karukonda, School of Medicine-Radiation Oncology
  • Yvonne Mowery, School of Medicine-Radiation Oncology