{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:41:35Z","timestamp":1790019695998,"version":"4.0.1"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"\n Importance<\/jats:title>\n Initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery is associated with improved outcomes among patients with head and neck squamous cell carcinoma. However, the relationship of barriers to care with timely PORT is unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To categorize barriers to timely PORT, evaluate the association of barriers to care with initiation of timely PORT, and describe the primary reason for delay among patients without timely PORT.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This prospective cohort study at a US academic medical center included adults with head and neck squamous cell carcinoma undergoing curative-intent surgery with an indication for PORT. Patients were recruited for the study from May 19, 2020, to November 6, 2023.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was initiation of timely PORT, defined as starting radiation therapy within 6 weeks of surgery. Barriers to PORT were prospectively collected via patient self-report and the electronic health record. Among patients who did not start PORT within 6 weeks of surgery, the primary reason for delay was defined as the singular barrier category that most directly led to the delay.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 78 patients (mean [SD] age, 61.5 [10.8] years; 54 males [69.2%]), 32 patients (41%) initiated PORT within 6 weeks of surgery, and 46 patients (59%) did not initiate PORT within 6 weeks of surgery. Each additional barrier was associated with a decreased odds of initiating timely PORT (adjusted odds ratio, 0.81 [95% CI, 0.63-1.01]); patients with 5 or more barriers had a 76% reduction in the odds of starting PORT within 6 weeks of surgery relative to those with 0 to 2 barriers (adjusted odds ratio, 0.24 [95 CI%, 0.06-0.84]) on multivariable analysis. When analyzed by barrier category, patients with a perioperative adverse effects\u2013related barrier were less likely to initiate timely PORT than patients without a perioperative adverse effects barrier (adjusted odds ratio, 0.17 [95% CI, 0.04-0.66]) on multivariable analysis. Among patients without timely PORT, the most common primary reason for delay was a barrier related to poor care coordination (19\/46 [41.3%]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this prospective cohort study, patients with a greater number of barriers and those with a barrier related to the perioperative adverse effects category were less likely to initiate timely PORT. Among patients without timely PORT, the most common primary reason for delay was a barrier related to poor care coordination. Efforts to improve timely PORT should focus on decreasing the number of barriers, improving surgical quality, and enhancing care coordination.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoto.2025.2824","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T15:00:34Z","timestamp":1757602834000},"page":"1186","source":"Crossref","is-referenced-by-count":9,"title":["Barriers and Timely Postoperative Radiation Therapy in Head and Neck Cancer"],"prefix":"10.1001","volume":"151","author":[{"given":"Megan T.","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Kistner-Griffin","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Medical University of South Carolina, Charleston"},{"name":"Hollings Cancer Center, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reid","family":"DeMass","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Medical University of South Carolina, Charleston"},{"name":"Hollings Cancer Center, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhisham S.","family":"Chera","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center, Medical University of South Carolina, Charleston"},{"name":"Department of Radiation Oncology, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chanita Hughes","family":"Halbert","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles"},{"name":"Norris Comprehensive Cancer Center, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine R.","family":"Sterba","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Medical University of South Carolina, Charleston"},{"name":"Hollings Cancer Center, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth G.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Medical University of South Carolina, Charleston"},{"name":"Hollings Cancer Center, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Nussenbaum","sequence":"additional","affiliation":[{"name":"American Board of Otolaryngology\u2013Head and Neck Surgery, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J.","family":"Alberg","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlad C.","family":"Sandulache","sequence":"additional","affiliation":[{"name":"Bobby R. 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