ACS National Navigation Roundtable Survey: Navigation for Timely Head and Neck Cancer Adjuvant Therapy

Dear ACS National Navigation Roundtable Member,

The American College of Surgeons/Commission on Cancer recently approved a new quality metric for head and neck cancer: time to initiation of postoperative radiation therapy. We are interested in understanding the present and future role of navigators in helping cancer centers meet their goal for this quality metric. To that end, we designed this survey to assess (1) the current landscape of navigation for patients with head and neck cancer through the treatment continuum and (2) barriers and facilitators to enhancing navigation through postoperative radiation therapy for patients with head and neck cancer.

Please forward this link to the person who is most knowledgeable about navigation services provided for patients with head and neck cancer at your organization/health system. This person may be a navigator or navigator supervisor. If there is someone in another organization who you think would be a valuable contributor to the survey, please feel free to forward this link to them as well.

Thank you for your engagement on this topic!

Elizabeth Calhoun, PhD, MEd

Electra Paskett, PhD

In what region of the United States is your practice located?

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New England (CT, MA, ME, NH, RI, VT)

Middle Atlantic (NJ, NY, PA)

South Atlantic (DC, DE, FL, GA, MD, NC, SC, VA, WV)

East North Central (IL, IN, MI, OH, WI)

East South Central (AL, KY, MS, TN)

West North Central (IA, KS, MN, MO, ND, NE, SD)

West South Central (AR, LA, OK, TX)

Mountain (AZ, CO, ID, MT, NM, NV, UT, WY)

Pacific (AK, CA, HI, OR, WA)

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Which of the following best describes your patient navigation practice-setting?

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Academic/NCI-designated

Comprehensive Community Cancer Program

Community Cancer Program

Integrated Network Cancer Program

Federally Qualified Health Center

Unsure

Other

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Please describe

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Which of the following best describes the types of treatments provided at your cancer program (Please Check all that apply)?

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Surgery

Radiation therapy

Systemic therapy

Other

N/A (I have a community based practice)

Which of the following best describes your navigation background?

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Nurse

Social Worker/Counselor

Patient

Allied Health

Other

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Please describe

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How long have you been in practice as a cancer patient navigator?

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< 1 year

1-5 years

6-10 years

> 10 years

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With respect to head and neck cancer, what percentage of the patients that are navigated have head and neck cancer? Would you say...

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My practice is exclusively dedicated to navigating patients with head and neck cancer

50-99% of my practice is dedicated to navigating patients with head and neck cancer

25-49% of my practice is dedicated to navigating patients with head and neck cancer

10-24% of my practice is dedicated to navigating patients with head and neck cancer

1-9% of my practice is dedicated to navigating patients with head and neck cancer

I do not ever navigate patients with head and neck cancer

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When considering navigation along the continuum, which of the following best describes your interactions navigating patients with head and neck cancer? Please select all that apply

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Initial intake from referral into my cancer program through the initial consultation

From the initial consultation at my cancer program through the initiation of treatment

From the initiation of treatment through the initiation of adjuvant therapy (when applicable)

From the initiation of treatment through the completion of treatment (including end of adjuvant therapy when applicable)

From the completion of treatment into survivorship

N/A (I do not provide navigation services for patients with head and neck cancer)

You reported that you do not currently help navigate patients with head and neck cancer through the process of initiating adjuvant radiation therapy. Which of the following answers best describes the reason?

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No time/too busy with other responsibilities

Not part of my job description (but some one else at my cancer program has this responsibility)

Not part of my job description (and no one else at my cancer program has this responsibility)

These patients have no need for navigation services

Other

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Please describe

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You reported that you help navigate patients with head and neck cancer through the initiation of adjuvant radiation therapy. Which of the following barriers do you encounter trying to help patients with head and neck cancer start adjuvant radiation therapy in a timely fashion? Please select all that apply

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Lack of patient knowledge about guidelines for timely initiation of adjuvant radiation therapy

Lack of patient perceived importance of timely adjuvant therapy (susceptibility to delays or consequences of delays)

Lack of patient knowledge about the process of starting adjuvant radiation therapy

Patient indecision about the need for adjuvant radiation therapy

Patient indecision about choosing a radiation facility

Challenges with communication between surgeons, radiation, and medical oncologists

Difficulty coordinating timely dental evaluations and extractions

Challenges scheduling necessary appointments in a timely fashion

Difficulty coordinating care across health systems/facilities

Transportation insecurity

Postoperative complications

Mistrust of the healthcare system

Inadequate health insurance coverage

Other

Please describe

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You reported that you help navigate patients with head and neck cancer through the initiation of adjuvant radiation therapy. Which of the following navigation services do you provide trying to help patients with head and neck cancer start adjuvant radiation therapy? Please select all that apply

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Assess patient barriers to timely, guideline-adherent adjuvant radiation therapy

Provide referrals to medical services

Provide referrals to social services

Provide one-on-one education about head and neck cancer and its treatment (including adjuvant therapy)

Enhance cultural alignment between the patient and the medical community

Help schedule appointments (e.g., radiation oncology, dental, etc)

Coordinate care between providers or clinics (e.g., radiation and medical oncology)

Track patients from surgery through the initiation of adjuvant radiation therapy

Call patients to remind them of appointments

Re-contact patients to confirm attendance at appointments and start of adjuvant radiation therapy

Make referrals or provide assistance with transportation

Make referrals or provide assistance with financial toxicity or health insurance coverage

Other

You reported that you do not currently help navigate patients with head and neck cancer through the initiation of adjuvant radiation therapy. Would you or your cancer center be interested in participating in a patient navigation program to help patients with head and neck cancer initiate adjuvant radiation therapy in a timely, guideline-adherent fashion?

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Yes

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Reason(s) for interest

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Reason(s) for lack of interest

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Which of the following best describes the barriers that you face (or would expect to face) in your cancer center or clinic when attempting to implement navigation to improve the initiation of adjuvant therapy for patients with head and neck cancer? Please select all that apply

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Lack of evidence supporting navigation to improve the timeliness of adjuvant therapy for patients with head and neck cancer

Adaptability of navigation to initiating timely adjuvant therapy for patients with head and neck cancer

Complexity of navigating adjuvant therapy for patients with head and neck cancer

Cost of navigating adjuvant therapy for patients with head and neck cancer

Needs and resources of patients with head and neck cancer are too extensive

Structural characteristics of my cancer clinic or cancer center

Culture of my cancer clinic or cancer center

Relative priority of head and neck cancer relative to other types of cancer

Relative priority of other aspects of the treatment continuum relative to adjuvant therapy

Organizational readiness to navigate patients with head and neck cancer through the start of adjuvant therapy

Available resources in my cancer clinic or cancer center to navigate patients with head and neck cancer through the start of adjuvant therapy

Other

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According to National Comprehensive Cancer Guidelines, for patients with head and neck cancer undergoing surgery and adjuvant radiation therapy, how soon after surgery should adjuvant radiation therapy commence? If you are not sure of the answer, please feel free to answer "I don't know".

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Nationally, approximately what percentage of patients with head and neck cancer undergoing surgery and postoperative radiation therapy experience a delay starting postoperative radiation therapy?

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< 20%

20-39%

40-59%

60-79%

>/= 80%

I don't know

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At your cancer program, approximately what percentage of patients with head and neck cancer undergoing surgery and postoperative radiation therapy experience a delay starting postoperative radiation therapy?

* must provide value

< 20%

20-39%

40-59%

60-79%

>/= 80%

I don't know

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Among patients with head and neck cancer, what metrics do you track? Please select all that apply

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Time to treatment initiation

Time to initiation of adjuvant radiation therapy

Barriers to care (assessed and resolved)

Social needs (e.g., transportation, housing, or food insecurity)

Navigation acuity/complexity

Time spent on navigation encounters

Navigator patient caseload

Referrals provided by the navigator

Emergency department visits

Unplanned hospitalizations

Appointment no-show rates

Other

Please describe

* must provide value

Among patients with head and neck cancer, what type of reports do you generate on your navigation program? Select all that apply

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Patient level (e.g., # of patient appointments and referrals made)

Navigator level (e.g., time spent on a given activity, patient caseload)

Healthcare utilization (e.g., emergency department visits, unplanned hospitalizations, no-show rates)

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