In this qualitative study of 21 otolaryngologists and radiation oncologists, clinicians identified potential barriers to deintensifying surveillance, including patient and physician peace of mind, need to maintain a physician-patient relationship, and need to adequately manage treatment-associated toxic effects and other survivorship concerns.
These findings suggest that incorporation of surveillance and survivorship education in training, positive reframing of surveillance deintensification, and creation of virtual survivorship programs may address some barriers to deintensification.
ImportanceSurveillance imaging and visits are costly and have not been shown to improve oncologic outcomes for patients with head and neck cancer (HNC). However, the benefit of surveillance visits may extend beyond recurrence detection. To better understand surveillance and potentially develop protocols to tailor current surveillance paradigms, it is important to elicit the perspectives of the clinicians who care for patients with HNC.
Design, Setting, and ParticipantsThis qualitative study was performed from January to March 2021. Guided by an interpretive description approach, interviews were analyzed to produce a thematic description. Data analysis was performed from March to April 2021. Otolaryngologists and radiation oncologists were recruited using purposive and snowball sampling strategies.
Main Outcomes and MeasuresThe main outcomes were current practice, attitudes, and beliefs about deintensifying surveillance and survivorship as well as patients values and perspectives collected from interviews of participating physicians.
ResultsTwenty-one physicians (17 [81%] men) were interviewed, including 13 otolaryngologists and 8 radiation oncologists with a median of 8 years (IQR, 5-20 years) in practice. Twelve participants (57%) stated their practice comprised more than 75% of patients with HNC. Participants expressed that there was substantial variation in the interpretation of the surveillance guidelines. Participants were open to the potential for deintensification of surveillance or incorporating symptom-based surveillance protocols but had concerns that deintensification may increase patient anxiety and shift some of the burden of recurrence monitoring to patients. Patient and physician peace of mind, the importance of maintaining the patient-physician relationship, and the need for adequate survivorship and management of treatment-associated toxic effects were reported to be important barriers to deintensifying surveillance.
Conclusions and RelevanceIn this qualitative study, clinicians revealed a willingness to consider altering cancer surveillance but expressed a need to maintain patient and clinician peace of mind, maintain the patient-clinician relationship, and ensure adequate monitoring of treatment-associated toxic effects and other survivorship concerns. These findings may be useful in future research on the management of posttreatment surveillance.
WSOMS is a voluntary partnership of dental professionals working together to improve the quality of oral and maxillofacial surgery services in the community. It is the belief of the Society that professional, political, social and economic exchange between states of the Sixth District of the AAOMS will result in a unity of voice which will enhance our effectiveness in our community and at the national level.
Our board president for 2019/20 is Dr. Elizabeth (Libby) Kutcipal, a maxillofacial surgeon with practice out of Ballard Oral & Maxillofacial Surgery, Seattle. Many of you had the opportunity to meet Libby at the 2019 Annual Meeting last March where she received the gavel from past-president Murray Jacobs. I emailed her a few questions for this months Member Spotlight. Here are her responses.
I did a GPR at the University of Washington and had significant exposure to maxillofacial surgery. I took out more teeth in my first week of the GPR than I did in all of dental school. I knew it was where I was meant to be!
I just returned from Nepal, traveling with a group called International Medical Relief. We provided care to many of the villagers along the Manaslu Circuit. I also went to Vietnam a few years ago to provide care. It is amazing what can be done with so few resources! Around the holidays, I get my neighbors together to support some families through the YWCA.
