Comprehensive Surgical Thyroid Management in a Rural Health System During the Global Pandemic

Introduction: Access to high-quality, comprehensive, subspecialty care is challenging in rural health care settings under ideal circumstances. In the clinically restricted environment created by the SARS-CoV-2 pandemic, this has been even more problematic. The regional distribution of a broad patient demographic across multiple tertiary care centers within a large rural health care system presents unique challenges. Here we describe our system platform for the management of a large population of thyroid patients across an expansive rural health system during the pandemic. Method(s): This retrospective review was approved by our institutional review board. Patients undergoing surgical management of thyroid and parathyroid disease were identified using a system electronic medical record via Current Procedural Terminology codes. Applications essential for management of these patients included implementation of an endocrine database, utilization of a multidisciplinary thyroid cancer tumor board, and coordination of regional patient access through the Geisinger System Program for Thyroid and Parathyroid Disorders. Result(s): We identified 930 endocrine surgical cases at our institution managed over the past 3 years. A total of 281 patients have been reviewed thus far. A total of 185 thyroid surgeries were performed on 173 patients. Final pathology was benign in 99 (53.5%) patients;77 (41.6%) were welldifferentiated thyroid carcinomas. The average elapsed days from fine needle aspiration biopsy to surgery was 54.8 (with those >100 days excluded). Average elapsed days from biopsy to surgery in patients with molecular testing was 61.5 days compared with 49.9 days for those without molecular testing. These 2 averages were significantly different from each other (P=.02) but not from the overall average. Conclusion(s): In this presentation, the effective management of a large population of thyroid patients is demonstrated through the utilization of several critical clinical applications. We propose a care delivery scheme for the evaluation and management of thyroid patients utilizing multiple clinical access points together with a multidisciplinary program for endocrine disease management.

Factors Impacting Rural Access to Head and Neck Cancer Care During COVID-19

Introduction: Access to specialty care is challenging in rural health environments, and this has been compounded by the COVID-19 pandemic. Routes to establishing care for head and neck cancer patients are especially important. We sought to quantify our referral patterns and processes to identify opportunities for optimization. Method(s): Retrospective review was performed of patients with initial head and neck tumor board presentation between January 1, 2020, through December 31, 2021. Assessed time points were date of referral, biopsy, pathological diagnosis, imaging order, imaging obtained, and initial presentation at head and neck tumor board. Result(s): A total of 429 patients were included. Squamous cell carcinoma (n=350, 81.6%) made up the majority, and most common primary sites were oropharynx (27.4%), oral cavity (20.3%), larynx (16.9%), and cutaneous (16.5%). At time of referral, 37.6% of patients had biopsy proven diagnosis. Average time to tumor board was 22 days, and significantly greater in those undiagnosed at referral (29 vs 14 days). Distance to provider did not correlate with time to tumor board. The period since the onset of the COVID crisis did not appear to affect access to care once in our system. However, there was evidence that patients presented with advanced locoregional disease during COVID-19. Conclusion(s): This study creates an approach to map access to care, evaluating critical time points and opportunities to expedite multiple steps that initiate therapy for head and neck cancer. There are both external (rural geography and the COVID-19 pandemic) and internal aspects that may pose barriers to access. Identification of these barriers allows for improved timely access to care in this susceptible population.

Optimizing rural access for head and neck cancer during COVID

Introduction: Access to head and neck specialty care is challenging in rural health environments, and this has been compounded by the COVID-19 crisis. We sought to quantify our referral patterns and processes to identify opportunities for optimization. Method: This retrospective record review was approved by our institutional review board. All new patients presented at weekly head and neck cancer tumor boards were tabulated for calendar year 2020, which included periods before and after the global pandemic was declared by the World Health Organization on March 11, 2020. Time points included were date of referral, date of pathology diagnosis, and date of tumor board presentation. A detailed data analysis will follow over the next several weeks. Results: A total of 259 new patients were presented at tumor boards during the study period. Most were squamous cell carcinoma (n = 188, 73%) primarily located in the oropharynx (24%), oral cavity (19%), larynx (17%), and cutaneous in origin (16%), with an overall relatively even distribution of T stage. Longer time points from date of referral to tumor board revealed some correlation with greater geographic distance. The period since the onset of the COVID crisis did not appear to affect access to care once in our system;however, there was some evidence that T stage was higher during this time period. Potential factors that affect access to care are reviewed. Conclusion: This study creates an approach to map access to care by evaluating critical time points and opportunities to expedite multiple steps that initiate therapy for head and neck cancer. There are both external (rural geography and the COVID crisis) and internal aspects that may pose barriers to access. These procedures may now be utilized to prospectively advance patient care.