New Dartmouth Cancer Center study finds rural patients face delays in head and neck cancer treatment

A new study from Dartmouth Cancer Center researchers shed light on the reasons many patients in rural communities face delays in receiving critical follow-up treatment after head and neck cancer surgery, and what can be done to address those gaps.

Published recently in JAMA Otolaryngology – Head & Neck Surgery, the study focuses on whether patients begin radiation therapy within the recommended six-week window after surgery, a timeline known to improve survival for people with head and neck squamous cell carcinoma.

“Despite clear guidelines, many patients across the U.S., especially those in rural areas, are not starting radiation therapy on time,” said lead author Garrett T. Wasp, MD, MPH, a medical oncologist at Dartmouth Cancer Center. “Our goal was to better understand why, by listening directly to patients, caregivers, and care teams.”

The study included interviews and structured discussions with patients, caregivers, and clinical staff at two rural-serving cancer clinics within Dartmouth Health. From those conversations, researchers identified five key challenges that often delay care:

•    Communication gaps between patients and care teams
•    Complex care coordination across multiple providers
•    Limited access to dental care required before radiation
•    Transportation barriers, especially in rural areas
•    The physical and emotional toll of recovering from cancer surgery

“These are not isolated issues—they intersect and compound one another,” said co-senior author Philip E. Schaner, MD, PhD, a radiation oncologist at Dartmouth Cancer Center. “For example, transportation barriers can delay dental clearance, which then delays radiation therapy.”

The study also highlighted strengths within rural communities that can help patients stay on track. Participants pointed to the value of dedicated care coordinators, strong community connections, and local resources that support patients throughout treatment.

Caregivers, in particular, were identified as essential to navigating the complexities of cancer care – often managing logistics, coordinating appointments, and advocating for patients.

“Caregivers are essential partners in care, but they also carry a great deal of responsibility,” Wasp said. “Supporting them more effectively is an important opportunity for improving outcomes.”

Building on these findings, the research team is now developing targeted, community-informed strategies to reduce treatment delays and improve access to care in rural areas.

“This work is about more than identifying problems—it’s about co-creating solutions with the people most affected,” Wasp said. “That’s how we move toward more equitable, patient-centered cancer care.”

Dartmouth Health, the nation’s most rural academic health system is committed to setting the standard in rural health care so that all people living in rural areas can live their healthiest lives. Among other key initiatives, Dartmouth Health founded the Center for Advancing Rural Health Equity in 2022.
 
“We’re especially grateful to the Agency of Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI), whose funding through Dartmouth’s Learning Health System E-STaR Center made this initial work possible,” acknowledged Wasp.