{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:33:44Z","timestamp":1787762024225,"version":"build-2784847793"},"reference-count":67,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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\u2010trained HNC surgeon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010r), Patient Health Questionnaire\u20109 (PHQ\u20109) for Depression, Generalized Anxiety Disorder\u20107 (GAD\u20107), and frailty. Data were analyzed using cross\u2010tabulations, multivariable linear regression, and multivariable survival analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most patients had incurable disease (73.9%), with significant improvement in ESAS\u2010r shortness of breath, ESAS\u2010r tiredness, GAD\u20107, and PHQ\u20109 scores at follow\u2010up. Mortality was 40.1%, and 84.2% of deaths occurred at home or in hospice. Aggressive end\u2010of\u2010life care occurred in 57.9% of patients and was associated with continued cancer\u2010directed treatment (79.4% vs. 26.1%), lower hospice use (55.9% vs. 82.6%), and death in an acute\u2010care facility (27.3% vs. 0%). Palliative immunotherapy was associated with reduced hospice duration (median\u2009=\u200915\u2009days [IQR\u2009=\u20094\u201363]) compared to other cancer\u2010directed treatment (median\u2009=\u200927\u2009days [23\u201363]) or supportive care (median\u2009=\u200968\u2009days [26\u2013162]). On multivariable analysis, surgery (HR\u2009=\u20090.08 [95% CI\u2009=\u20090.01\u20130.39]) and \u2265\u20093 PC visits (HR\u2009=\u20090.24 [0.08\u20130.73]) were independent prognostic indicators of survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients seen in a surgeon\u2010led 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70863","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:11:43Z","timestamp":1787760703000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of a Novel Subspecialty Outpatient Palliative Medicine Head and Neck Cancer Clinic"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5134-9307","authenticated-orcid":false,"given":"Christine G.","family":"Gourin","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Fakhry","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2902-4407","authenticated-orcid":false,"suffix":"Jr.","given":"Nyall R.","family":"London","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2682-3297","authenticated-orcid":false,"given":"Leila J.","family":"Mady","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne M.","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4105-7092","authenticated-orcid":false,"given":"Wojciech K.","family":"Mydlarz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Eisele","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn M.","family":"Frazier","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Quon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliyah","family":"Pabani","sequence":"additional","affiliation":[{"name":"Department of Oncology Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandi R.","family":"Page","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Kut","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana P.","family":"Kiess","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Boudadi","sequence":"additional","affiliation":[{"name":"Department of Oncology Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengcheng","family":"Gui","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Hann","sequence":"additional","affiliation":[{"name":"Department of Oncology Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7068-9534","authenticated-orcid":false,"given":"Maie St.","family":"John","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Johns Hopkins Medical Institutions  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1002\/cam4.546","article-title":"National Treatment Patterns in Patients Presenting With Stage IVC Head and Neck Cancer: Analysis of the National Cancer Database","volume":"4","author":"Schwam Z. 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