Jessica H. Maxwell, MD, MPH, FACS, received a $50,000 Telehealth Research and Innovation for Veterans with Cancer (THRIVE) grant from the Office of Rural Health to address barriers like distance and rurality in patients with head and neck cancer.
“The goal is to improve the time to post-operative radiation treatment, which is recommended within six weeks by the National Comprehensive Cancer Network (NCCN) guidelines,” said the Chief of Otolaryngology, Pittsburgh Veteran’s Affairs Medical Center and Associate Professor, Department of Otolaryngology-Head & Neck Surgery.
This timing is problematic because it is difficult to start radiation after surgery in such a short window of time. After a big surgery, for example, Dr. Maxwell said multiple referrals are needed for dental visits, palliative care, radiation oncologist, and a speech-language pathologist, just to name a few.
“At the VA, less than half of the veterans are actually following through with that guideline to get radiation treatment within six weeks,” Dr. Maxwell added.
Part of her research will involve talking to veterans and their caregivers and community providers to see what is going on. Many different factors lead to a delay in treatment, and some involve rurality. How far away does a patient live? “The farther patients live from their treating hospital, the worse they do, unfortunately,” Dr. Maxwell said. “In the VA, about 60% of our patients here in Western Pennsylvania live in rural or highly rural communities. So, there’s a lot of setbacks and barriers that our veterans face.”
The first aspect of this pilot grant will be to look at the veteran population with head and neck cancer nationwide and see where the barriers exist. “This is not just an issue in our community in Western Pennsylvania,” Dr. Maxwell said. They will look through National Veterans Affairs databases to see how they can identify certain factors related to delays in post treatment radiation.
Next will be interviewing and conducting focus groups with veterans and their caregivers and community providers to see where they think those barriers are. “It doesn’t make sense to implement a new project unless everyone is on board,” Dr. Maxwell explained. “Particularly, you need the patients to be on board because it’s their care that we’re talking about.”
The third aspect of the project will be to implement some strategies to improve the time to post-operative radiation treatment. The goal is to utilize telehealth, because many veterans use it already for their clinical appointments. There are also many community-based outpatient clinics in the VA system that can be used as communication sites from the main tertiary care hospital center. “If it’s challenging for a veteran to travel the distance to get to the tertiary care center, then we will come to them, through the use of telehealth.”
The goal is to extend and develop these strategies over the next two to three years.