The Role of Collaboration in Early Palliative Care Referrals for Head and Neck Cancer

Head and neck cancer chemotherapy and radiotherapy given over a 6-week treatment regimen produces significant symptoms. These symptoms escalate during weeks 2 and 3, continuing for weeks or months after treatment. This impacts quality of life and can result in delays or cessation of treatment. Involvement of palliative care earlier in treatment can result in improved cancer-related symptoms, quality of life, and patient outcomes. The primary aim of this project was to improve the timing of palliative care referrals for patients with head and neck cancer, ideally before week 2 of treatment. The secondary aim of the project was to assess whether patient-reported pain and distress scores improved from the initial visit to visit 2 with palliative care. A retrospective chart audit was completed for baseline data. The project intervention included a multiteam collaborative huddle to educate referral sources about the benefit of earlier palliative care referrals. Results showed improved referral timing from 28% to 7% referred greater than 14 days after initiation of cancer treatment. For the 58 charts with completed pain and distress scores, 46.5% of patients had improved pain scores, and 53.4% had improvement in distress scores from the first to the second palliative care visits.