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Understanding Distress and Disparities in Head and Neck Cancer Care (2025-2026)

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

Almost half of the patients treated for HNC at Duke have clinically meaningful distress; there is an association between clinically meaningful distress and marital status, which is considered a marker for social support. 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

Building on the work of a previous team, this project aims to improve health outcomes for HNC patients with increased social risk factors and identified distress. The team will work directly with HNC patients with three primary goals:

  1. Identify existing racial/ethnic disparities in social risk factors and heightened distress among patients diagnosed with HNC at Duke Hospital. Team members will perform a prospective study that will assess adverse social risk and distress among newly diagnosed HNC patients at Duke University Hospital who plan to undergo surgical treatment.
  2. Evaluate the impact of a pilot community resource referral program for HNC patients with increased social risk factors. Team members will provide patients with community-based resources and then conduct follow-up phone calls with patients after two weeks from the initial referral to assess patient usage and identify any barriers.
  3. Examine disparities in utilization of follow-up care among HNC patients with social risk and distress. Team members will conduct a retrospective cohort study that will examine racial/ethnic disparities in social risk factors, distress and follow-up care adherence among HNC patients receiving care at Duke Hospital.

Anticipated Outputs

Conference presentations; publication(s); data collection for a new student-driven program

Student Opportunities

Ideally, this project team will include 2-3 graduate students and 3-4 undergraduate students interested in sociology, psychology or health policy. All applicants should have an interest in social determinants of health, cancer-related distress and health equity research, as well as an interest in working with underserved communities.

Team members will gain a better understanding of health disparities research and learn how to design and evaluate health-equity driven initiatives. They will have the opportunity to learn about cancer-related distress and social risk in head and neck cancer care by contributing to a literature review on the topic, developing a health-equity project screening patients for cancer distress and designing and establishing a long-term student-run program to continue this screening. They will also gain hands-on experience working with affected patients by making follow-up calls for patients who receive referrals through the pilot community-based resource referral program and connecting them to resources.

There is an optional summer component, where students may work four hours per week during the month of July.

Timing

Summer 2025 – Spring 2026

  • Summer 2025 (optional): Add amendment to existing IRB from current Bass Connections project; conduct literature review; start identifying patients to enroll in study
  • Fall 2025: Survey identified patients to screen for distress using the NCCN Distress Thermometer; refer patients to community-based resources; conduct 2-week follow-up phone calls for patients who received referrals
  • Spring 2026: Analyze data; present project at academic conferences; submit manuscript publication(s)

Crediting

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

See earlier related team, Understanding Disparities to Follow-Up Care in Head and Neck Cancer (2024-2025).

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

Team Contributors

  • Cheyenne Corbett, School of Medicine: Comprehensive Cancer Center
  • Laura Fish, Family Medicine and Community Health: Community Health
  • Pooja Karukonda, School of Medicine: Radiation Oncology
  • Katherine Ramos, School of Medicine: Psychiatry and Behavioral Sciences