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Head and Neck Surgery

(200) Factors Impacting Rural Access to Head & Neck Cancer Care

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • VD

    Vincent M. Desiato, DO

    Resident Physician
    Geisinger Health System
    Danville, Pennsylvania, United States

    • Co-Author(s)

  • NP

    Nicholas C. Purdy, DO FACS

    Director, Head and Neck Service
    Geisinger Health System
    Danville, PA, United States

  • Kenneth W. Altman, MD PhD

    Professor and Chair
    Geisinger Health System and Geisinger Commonwealth School of Medicine
    Danville, PA, United States

  • Kevin P. Stavrides, MD

    Physician
    Geisinger Health System and Geisinger Commonwealth School of Medicine
    Geisinger Medical Center, PA, USA

  • TH

    Thorsen W. Haugen, MD

    Associate Professor
    Geisinger Health System
    Danville, Pennsylvania, USA

  • Kevin J. Kovatch, MD

    Assistant Professor, Attending Surgeon
    Geisinger Health System
    Danville, Pennsylvania, United States

    • Senior Author(s)

  • PP

    Phillip K. Pellitteri, DO

    Clinical Professor, Attending Surgeon, Regional Medical Director
    Geisinger Health System
    Bloomsburg , PA, USA

Disclosure(s):
Kenneth W. Altman, MD PhD: No relevant relationships to disclose.
Kevin J. Kovatch, MD: No relevant relationships to disclose.


Introduction: Access to specialty care is challenging, particularly in rural health environments. Routes to establishing care for head & neck cancer patients is especially important. We sought to quantify our referral patterns and processes to identify opportunities for optimization.

Methods: This study was approved by our institutional IRB. All new patients presented at head & neck cancer tumor board were retrospectively reviewed from 1/1/2020-12/31/2022. Referral date, time to pathology diagnosis, and tumor board presentation were tabulated. Impact of geographic distance and tumor stage were also computed.

Results: A total of 609 new patients were presented at tumor board during the study period. The majority were squamous cell carcinoma (n=493, 81.0%), primarily located in the oropharynx (29.2%), oral cavity (20.5%), larynx (17.7%), and cutaneous in origin (17.4%), with an overall relatively even distribution of T-stage. Longer time points from date of referral to tumor board revealed some correlation with greater geographic distance. The impact of distance on T-stage at presentation was not statistically significant, but there was a trend toward higher T-stage with greater distance.

Conclusions: This study creates an approach to map access to care, evaluating critical time points and opportunities to expedite multiple steps that initiate therapy for head & neck cancer. There are both external (rural geography, socioeconomic) and internal aspects that may pose barriers to access.