Survivorship care before radiotherapy ends is linked to better adherence and survival

Design

Retrospective single-centre cohort

Population

471 patients receiving curative radiotherapy for head and neck cancer

Primary outcome

Radiotherapy adherence, 3-year recurrence and disease-free survival

Effect

Non-adherence OR 0.45 (95% CI 0.27 to 0.75); DFS HR 0.61 (0.41 to 0.91)

A US single-centre cohort included 471 patients receiving curative-intent radiotherapy for head and neck cancer between 2018 and 2025. About a third (148) attended a multidisciplinary survivorship clinic before finishing radiotherapy.

After adjustment for tumour stage, systemic therapy, smoking, insurance, deprivation and other factors, attendees had lower odds of radiotherapy non-adherence (OR 0.45, 95% CI 0.27 to 0.75), lower 3-year recurrence (subdistribution HR 0.62, 0.40 to 0.94) and better 3-year disease-free survival (HR 0.61, 0.41 to 0.91). Only about half the cohort fully adhered to radiotherapy.

The idea is that dealing with swallowing, nutrition, pain, mood and social problems during treatment keeps patients on schedule, and interruptions to head and neck radiotherapy are known to harm control. Survivorship care usually starts after treatment, so this argues for moving it earlier.

This was observational, and patients who attend an extra clinic may differ in motivation and support in ways adjustment cannot capture. It is a strong reason to try earlier integration, not proof that it improves survival.

• Consider referring patients to supportive or survivorship services before radiotherapy begins or early in the course.
• Screen for swallowing difficulty, weight loss, pain and low mood during treatment.
• Flag patients at risk of missing fractions, such as those travelling long distances.
• Address practical barriers, such as transport and accommodation, early.

Why it matters

Missed fractions cost tumour control, and early support may prevent them.

Don't overread it

This was observational; it cannot show that the clinic itself improved survival.

The statistics, in plain English

A hazard ratio of 0.61 for disease-free survival means about 39% lower risk of recurrence or death over the period. Because patients chose whether to attend, unmeasured differences could explain part of this.

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