Implementation of a Novel Subspecialty Outpatient Palliative Medicine Head and Neck Cancer Clinic.

Authors

Christine G Gourin, Carole Fakhry, Nyall R London, Leila J Mady, Wayne M Koch, Wojciech K Mydlarz, David W Eisele, Kaitlyn M Frazier, Harry Quon, Aliyah Pabani, Brandi R Page, Carmen Kut, Ana P Kiess, Karim Boudadi, Chengcheng Gui, Christine Hann, Maie St John

Published in

The Laryngoscope. Aug 26, 2026. Epub Aug 26, 2026.

Abstract

Head and neck cancer (HNC) patients have high palliative care (PC) needs. We reviewed our initial experience with a novel subspecialty HNC outpatient PC clinic, led by a Hospice and Palliative Medicine fellowship-trained HNC surgeon.
We retrospectively reviewed 142 patients referred to a novel subspecialty HNC PC clinic between July 2023 and March 2025. Symptom evaluation included the revised Edmonton Symptom Assessment System (ESAS-r), Patient Health Questionnaire-9 (PHQ-9) for Depression, Generalized Anxiety Disorder-7 (GAD-7), and frailty. Data were analyzed using cross-tabulations, multivariable linear regression, and multivariable survival analysis.
Most patients had incurable disease (73.9%), with significant improvement in ESAS-r shortness of breath, ESAS-r tiredness, GAD-7, and PHQ-9 scores at follow-up. Mortality was 40.1%, and 84.2% of deaths occurred at home or in hospice. Aggressive end-of-life care occurred in 57.9% of patients and was associated with continued cancer-directed treatment (79.4% vs. 26.1%), lower hospice use (55.9% vs. 82.6%), and death in an acute-care facility (27.3% vs. 0%). Palliative immunotherapy was associated with reduced hospice duration (median = 15 days [IQR = 4-63]) compared to other cancer-directed treatment (median = 27 days [23-63]) or supportive care (median = 68 days [26-162]). On multivariable analysis, surgery (HR = 0.08 [95% CI = 0.01-0.39]) and ≥ 3 PC visits (HR = 0.24 [0.08-0.73]) were independent prognostic indicators of survival.
Patients seen in a surgeon-led subspecialty HNC PC clinic demonstrated observed longitudinal improvement in symptom scores, improved survival in patients receiving longitudinal PC, and a high rate of home or hospice deaths. These data suggest that subspecialist HNC PC adds value to multidisciplinary HNC care.

PMID:
42647137
Bibliographic data and abstract were imported from PubMed on 27 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.