Survivorship Care Before Completion of Definitive Radiotherapy and Oncologic Outcomes in Head and Neck Cancer

Abstract

Importance Across cancer populations, a growing and aging survivor population combined with increasing use of multimodal therapy has expanded the need for survivorship care, particularly in head and neck cancer (HNC). Although survivorship begins at diagnosis, survivorship care is often emphasized after treatment completion, and whether earlier integration during treatment is associated with adherence to treatment and survival remains unclear. Objective To evaluate whether early multidisciplinary survivorship care before definitive radiotherapy completion is associated with adherence and survival outcomes. Design, Setting, and Participants This retrospective cohort study included patients diagnosed with HNC who completed definitive curative-intent radiotherapy at an academic center between March 21, 2018, and March 25, 2025. Patients treated with primary surgery and those receiving palliative-intent radiotherapy were excluded. Exposures Attendance at a multidisciplinary HNC survivorship clinic before radiotherapy completion. Covariates were sex, race, age and marital status at diagnosis, tumor and nodal categories, history of tobacco or alcohol use, insurance status, treatment with systemic therapy, year of diagnosis, Area Deprivation Index national rank, and cancer site. Main Outcomes and Measures The primary outcomes were radiotherapy adherence, 3-year recurrence risk, and 3-year disease-free survival (DFS). Radiotherapy adherence was evaluated using logistic regression, DFS using Cox proportional hazards regression, and recurrence using Fine-Gray regression. Results Among 471 patients in the overall cohort (83 [17.6%] female; 388 [82.4%] male), 148 (31.4%) received early survivorship care, and 247 (52.4%) adhered to radiotherapy. In multivariable analysis adjusting for clinical and sociodemographic factors, attendees had lower odds of radiotherapy nonadherence (odds ratio, 0.45; 95% CI, 0.27-0.75), lower 3-year recurrence risk (subdistribution hazard ratio [SHR], 0.62; 95% CI, 0.40-0.94), and improved 3-year DFS (HR, 0.61; 95% CI, 0.41-0.91). Conclusions and Relevance In this study, after adjustment for clinical and sociodemographic factors, early survivorship care was associated with improved radiotherapy adherence and survival among patients with HNC. These findings suggest that earlier integration of multidisciplinary survivorship care, rather than solely after treatment, may be a modifiable care delivery strategy with potential relevance across cancer populations.

The authors' abstract, as published at the source. JAMA Otolaryngology–Head & Neck Surgery, 2026 · DOI ↗