TIMELY initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery is a critical factor in improving outcomes for patients with head and neck squamous cell carcinoma. A prospective cohort study from a U.S. academic medical center has revealed that cumulative barriers to care, particularly those tied to perioperative complications and poor care coordination, substantially decrease the likelihood of patients receiving PORT on time.
The analysis included 78 patients undergoing curative-intent surgery with an indication for PORT between May 2020 and November 2023. Only 32 patients, or 41%, began radiation within the 6-week target window. In contrast, 59% experienced delays beyond this threshold.
The impact of barriers was striking. Each additional barrier was associated with reduced odds of timely PORT initiation. Patients facing five or more barriers had a 76% lower chance of starting radiation within 6 weeks compared with those encountering only zero to two obstacles. Among specific categories, perioperative adverse effects emerged as a particularly powerful predictor of delay, with patients affected by these complications significantly less likely to achieve timely treatment.
For patients who did not meet the treatment window, poor care coordination was the most frequently identified primary cause, accounting for over 40% of delays. The findings emphasize that logistical challenges in managing transitions of care may be just as influential as medical complications in determining whether patients receive radiation promptly.
The study underscores the need for health systems to streamline coordination across surgical and oncology teams, minimize postoperative complications, and address cumulative barriers that patients face. According to the authors, targeted interventions to improve communication and reduce care fragmentation could help ensure that more patients access radiation therapy within the recommended timeframe, ultimately improving oncologic outcomes.
Reference: Nguyen M et al. Barriers and timely postoperative radiation therapy in head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2025. doi: 10.1001/jamaoto.2025.2824
