New study pinpoints barriers to timely head and neck cancer treatment in rural areas

LEBANON, N.H. — A new study led by researchers at Dartmouth Cancer Center pinpoints why many patients in rural areas experience delays in receiving critical follow-up treatment for head and neck cancer, and what can be done to address those gaps.

Published in JAMA Otolaryngology–Head & Neck Surgery, the study examines factors that influence whether patients begin postoperative radiotherapy within the recommended six-week window after surgery, the timeframe known to improve survival for patients 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 qualitative study engaged patients, caregivers, and clinical staff from two rural-serving cancer clinics at Dartmouth Health. Through structured discussions, researchers identified five main interconnected challenges that can delay treatment. These challenges include:

1. Difficulties with communication between patients and care teams
2. Complex care coordination across multiple providers
3. Limited access to dental care required before radiation
4. Transportation barriers including unreliable public transportation in rural settings
5. The immense emotional and physical strain that often accompanies recovery from cancer surgery.

“These are not isolated issues—they intersect and compound one another,” said 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 team facilitated dialogues with patients, caregivers, staff, and community engagement studios, which also highlighted strengths that can help patients stay on track with treatment. Feedback from the conversations pointed to the value of dedicated staff who serve as consistent points of contact, and the importance of strong community ties in rural areas and the ability to draw on existing health systems and community-based resources.

Caregivers, in particular, emerged as central to navigating the complexity of cancer care, including managing logistics 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.”

Patients also emphasized peer support, consistently telling the research team that hearing from others who had gone through similar experiences made a meaningful difference. “Peer support can help people feel less alone and more prepared,” Schaner said.

With contextually grounded data in place, Wasp and Schaner’s team has begun developing a system of multilevel interventions to reduce treatment delays and improve equity in cancer care for rural populations. By leveraging both the challenges posed and the opportunities offered by rural culture and resources, the team can focus on effective community-engaged approaches to address common challenges, shorten care timelines, and ultimately reduce survival disparities in rural head and neck cancer care.

“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.”