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Video

Head and Neck Surgery

(A505) Advanced Care Planning and Palliative Care are Underutilized in Head and Neck Cancer Recurrence Patients

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Zachary E. Thompson, BS

    Medical Student
    Keck School of Medicine
    Woodland Hills, California, United States

    • Co-Author(s)

  • Talia A. Wenger, BA

    Medical Student
    Keck School of Medicine
    South Pasadena, California, United States

    • Co-Author(s)

  • PP

    Peter Phung, MD, MBA

    3. Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Keck School of Medicine, United States

  • MN

    Margaret Nurimba, MD

    Head and Neck Oncology/Microvascular Surgery Fellow
    Icahn School of Medicine at Mount Sinai
    New York, New York, United States

  • AH

    Albert Y. Han, MD, PhD

    USC Caruso Department of Otolaryngology - Head and Neck Surgery, United States

  • Tamara N. Chambers, MD

    Associate Professor of Clinical Otolaryngology-Head and Neck Surgery
    Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California
    Los Angeles, CA, United States

    • Senior Author(s)

  • US

    Uttam K. Sinha, MD

    Professor
    Caruso Department of Otolaryngology - Head and Neck Surgery, United States

Disclosure(s):
Zachary E. Thompson, BS: No relevant relationships to disclose.
Margaret Nurimba, MD: No relevant relationships to disclose.
Tamara N. Chambers, MD: No relevant relationships to disclose.


Introduction: Head and neck cancer (HNC) carries a high rate of recurrence, morbidity, and mortality. Despite ample literature touting the merits of palliative care (PC) and advance care planning (ACP) in cancer patients, the rate of utilization in HNC patients is understudied. Further, the impact of hospital type on access to ACP and PC is poorly understood. We uncovered the rate and timing of ACP and PC utilization in patients with HNC recurrence in two hospitals.

Methods: This retrospective cohort study evaluated adults with recurrent HNC at Keck Hospital and LA General Medical Center (LAGMC) between 01/01/2016 – 01/01/2018 (n=289). Primary outcomes were mortality rate, time from utilization of or encounters for PC to death, and prevalence of advance directive (AD) or POLST (Physicians’ Orders for Life Sustaining Treatment). Descriptive statistics were evaluated with one-way ANOVA with a designated significance of 0.05.

Results: The Keck patient population is predominantly white and insured, while that of LAGMC is non-white and on Medicaid. Of 198 Keck patients with recurrent HNC (61.1% deceased), 17.7% had an AD and 7.57% had a POLST. Of 91 LAGMC patients (74.7% deceased), 5.49% had an AD and 13.2% had a POLST. 10.1% of Keck patients saw PC after recurrence, on average 76.7 days prior to death. 35.2% of LAGMC patients saw PC, on average 126.5 days prior to death (p=0.30). 25.7% of Keck patients and 54.5% of LAGMC patients had at least one documented Goals of Care conversation (GoCC) after recurrence. Among deceased patients, the initial GOCC was, on average, 198.4 days and 173.1 days prior to death for Keck and LAGMC patients, respectively (p=0.73). Female patients were significantly more likely to have an AD than male patients at Keck (p < 0.001). There were no other significant differences in likelihood of having an AD, POLST, PC, or GoCC based on demographics.

Conclusions: These data highlight a significant underutilization of ACP, GoCCs, and PC in patients with HNC recurrence as well as significant variation between the two hospitals. Despite poor overall prognosis, many patients lack documentation of their end-of-life care preferences.