Nurse Navigation on Time to Postoperative Radiation Therapy after Transoral Robotic Surgery for Oropharyngeal Carcinoma

OBJECTIVE: Postoperative radiation therapy (PORT) initiation within 6 weeks of surgery is associated with improved oncologic outcomes in head and neck cancer, but delays remain common. Oncology nurse navigators (ONN) may improve care coordination. This study evaluates time to PORT following transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) after ONN implementation. STUDY DESIGN: Retrospective chart review. SETTING: Academic tertiary care center. METHODS: Patients with HPV-associated OPSCC treated with TORS followed by PORT between January 2016 and March 2024 were included. RESULTS: Ninety-nine patients were included. Median age was 60 years and 85.9% were male. 57.6% were treated after ONN implementation. Most received PORT within our integrated academic health system (75.8%). Following ONN implementation, time from TORS to PORT decreased from 50 to 44 days (P = .02), and was associated with treatment within the integrated academic health system (52-43 days, P = .01), adjuvant chemoradiation therapy (CRT) (56-44 days, P = .02), and adjuvant proton beam therapy (PBT) (52-44 days, P = .004). Among PBT-treated patients, PORT initiation within 6 weeks increased from 6.7% to 38.3% (P = .02). The proportion of patients completing their adjuvant treatment within 100 days of TORS increased from 61.9% to 93% (P < .001). CONCLUSION: ONN implementation is associated with earlier PORT initiation and shorter treatment package time following TORS for HPV-associated OPSCC, with the greatest improvement observed among patients receiving PBT, CRT, and those treated within the integrated academic health system.