Anyone on the care team can see where a patient is in the process and act quickly if something needs attention.
Philip E. Schaner, MD, PhDFor patients with head and neck cancer, what happens after surgery can be just as important as the operation itself. At Dartmouth Cancer Center (DCC), a team of clinicians and researchers is working to make that next phase of care more timely, coordinated, and supportive—especially for patients in rural communities.
Led by medical oncologist Garrett T. Wasp, MD, MPH, and radiation oncologist Philip E. Schaner, MD, PhD, the project focuses on improving the timely transition from surgery to radiation therapy.
Why timing matters
After surgery, many patients need radiation therapy to reduce the risk of cancer returning. National guidelines recommend starting radiation treatment within six weeks of surgery to significantly improve survival.
“Starting radiation on time can make a meaningful difference in long-term outcomes,” Schaner says. “It’s one of the most important quality measures we have in head and neck cancer care.”
Despite this, delays are common nationwide. At DCC, early findings showed that many patients were not meeting the six-week window, prompting the team to investigate why.
A complex path
Moving from surgery to radiation involves far more than scheduling a single appointment. Patients with head and neck cancers must recover from surgery, wait for pathology results, attend follow-up visits, and often complete intensive dental work before radiation can begin safely. Even small delays quickly add up.
For those living in rural northern New England, this path is often compounded by distance and limited access to specialists and services outside of the Dartmouth Health system, such as dental care.
“We care for patients who may live hours away,” Wasp says. “They’re arranging transportation, taking time away from work, and preparing for 30 daily radiation treatments, all while navigating new challenges with vital functions such as eating, speaking, and breathing as they recover from major surgery.”
Learning from patients and caregivers
To better understand these challenges, Wasp and Schaner combined data analysis with real-life conversations involving patients, caregivers, and clinical staff. These discussions revealed not only logistical barriers but also the emotional and informational strain that patients experience.
“It’s a lot to take in, especially right after surgery,” Wasp says. “We heard clearly that patients need more support and guidance—not just medically, but emotionally and logistically as well.”
One of the most powerful insights came directly from patients, who emphasized the importance of connecting with others who have been through similar experiences.
In response, the project incorporates peer support advocates—individuals who have faced head and neck cancer and are willing to support others going through treatment. These advocates offer practical advice, empathetic reassurance, and a sense of connection during a challenging time.
“There’s something uniquely meaningful about talking with someone who truly understands,” Wasp says. “In rural communities, that sense of neighbor helping neighbor really matters.”
A new tool to keep care on track
With a greater understanding in place of the many moving parts of head and neck cancer care, Wasp’s and Schaner’s team developed NavPORT, which stands for Navigation for Postoperative Radiation Therapy. It’s a system designed to help patients and care teams stay on schedule.
At the heart of NavPORT is a digital dashboard built into the electronic medical record. The dashboard was developed in close collaboration with head and neck nurse navigator Michelle Coogan, RN, whose day-to-day experience coordinating patient care greatly helped shape its design.
By bringing a patient’s plan into one centralized, easy-to-read view, the tool uses simple visual cues to help providers track each patient’s progress through key steps, such as dental visits, imaging, and follow-up appointments, and quickly identify when something is falling behind. It also enhances coordination across specialties, ensuring everyone is working toward the same timeline.
“The goal is to make sure no one slips through the cracks,” Schaner says. “Anyone on the care team can see where a patient is in the process and act quickly if something needs attention.”
Building better systems for rural care
Beyond the dashboard, the initiative includes efforts to improve communication, strengthen partnerships with community providers, and give patients clearer, more timely information.
“It takes a team—patients, caregivers, clinicians, and staff—to make something like this work,” Wasp says. “By working together, we can help ensure that every patient has the best possible chance at timely, effective cancer care, regardless of where they live.”
NavPORT is now being piloted and refined at DCC, with early insights already guiding improvements across the care team. For patients facing head and neck cancer, that kind of compassionate coordination can make all the difference.
"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," acknowledges Wasp.