A qualitative exploration of the pathway to diagnosis and treatment of cutaneous squamous cell carcinoma of the head and neck with perineural spread

Poorva Pradhan; Ke Zoe Wan; Li Chan; Tsu-Hui Hubert Low; Raymond Wu; Jenny H Lee; Carsten E Palme; Jonathan R Clark; Rebecca L Venchiarutti

doi:10.1002/cam4.70118

A qualitative exploration of the pathway to diagnosis and treatment of cutaneous squamous cell carcinoma of the head and neck with perineural spread

Cancer Med. 2024 Aug;13(16):e70118. doi: 10.1002/cam4.70118.

Authors

Poorva Pradhan¹, Ke Zoe Wan², Li Chan³, Tsu-Hui Hubert Low^{1

4

5}, Raymond Wu^{4

6}, Jenny H Lee^{7

8}, Carsten E Palme^{1

4}, Jonathan R Clark^{1

4

9}, Rebecca L Venchiarutti^{1

2}

Affiliations

¹ Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
² Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
³ Department of Radiation Oncology, St George Hospital, Kogarah, New South Wales, Australia.
⁴ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁵ Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
⁶ Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
⁷ Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
⁸ Faculty of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
⁹ Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia.

Abstract

Background: Perineural spread (PNS) is associated with a poor prognosis in cutaneous squamous cell carcinoma of the head and neck (cSCCHN). Hence, investigating facilitators and barriers of early diagnosis and treatment of PNS in cSCCHN may improve outcomes.

Methods: Patients were recruited from an institutional database. Semi-structured interviews were conducted according to the Model of Pathways to Treatment. Thematic analysis was based on the four main intervals in the framework using a data-driven analytical method.

Results: Seventeen participants were interviewed. Facilitators included patients' past experiences, symptom progression, trust in healthcare professionals (HCPs), and capacity to leverage relationships. Barriers included difficult diagnoses, limited access to cancer services, lack of care coordination, and lack of awareness of PNS among primary health care providers.

Conclusion: These findings emphasise the complexity early diagnosis and treatment of PNS. Interventions like clinical practice guidelines, education for HCPs, and telehealth could facilitate timely detection and management.

Keywords: Perineural spread; cutaneous squamous cell carcinoma; head and neck; models of pathways to treatment; neoplasm.

MeSH terms

Aged
Aged, 80 and over
Carcinoma, Squamous Cell / diagnosis
Carcinoma, Squamous Cell / pathology
Carcinoma, Squamous Cell / therapy
Female
Head and Neck Neoplasms* / diagnosis
Head and Neck Neoplasms* / pathology
Head and Neck Neoplasms* / therapy
Humans
Male
Middle Aged
Qualitative Research
Skin Neoplasms* / diagnosis
Skin Neoplasms* / pathology
Skin Neoplasms* / therapy
Squamous Cell Carcinoma of Head and Neck / diagnosis
Squamous Cell Carcinoma of Head and Neck / pathology
Squamous Cell Carcinoma of Head and Neck / therapy

Grants and funding

Cancer Institute NSW