(31) Bridging the Follow-Up Gap in Head and Neck Cancer: Overcoming Barriers to Postoperative Care

Abstract:
Statement of the Problem: Nasal squamous cell carcinoma (SCC) is a rare but aggressive malignancy with a high risk of recurrence, necessitating rigorous post-treatment surveillance to optimize patient outcomes. Despite advancements in surgical and oncologic therapies, loss to follow-up (LTFU) remains a significant risk factor for disease progression and mortality. Socioeconomic barriers, psychological distress, and systemic healthcare disparities contribute to disengagement from post-treatment care. This case highlights a fatal recurrence of nasal SCC following LTFU, underscoring the urgent need for structured follow-up protocols to prevent avoidable disease progression.
Materials and

Methods: A review of current literature on nasal SCC, recurrence risk, and follow-up adherence in head and neck cancer patients was performed. Databases searched included MEDLINE via PubMed, Scopus, and Embase, with a focus on studies evaluating post-treatment surveillance, barriers to follow-up, and outcomes in SCC patients.
Methods of Data Analysis: Relevant studies were analyzed for recurrence rates, survival outcomes, and factors associated with LTFU in head and neck cancer patients. The patient’s clinical course was compared to established risk factors and patterns of recurrence in nasal SCC.

Results: A 43-year-old male with a history of tobacco use, anxiety, and homelessness was diagnosed with moderately differentiated nasal SCC, confirmed via biopsy and imaging. Initial management included total rhinectomy, with postoperative pathology revealing pT4aNxMx staging, positive surgical margins, and extensive nasal and maxillary involvement, necessitating adjuvant chemoradiotherapy. However, the patient was lost to follow-up due to psychosocial distress, depression, and substance use, leading to disengagement from care.
Seven months later, he presented with severe facial ulceration, progressive respiratory distress, and vision impairment due to an enlarging mass. Imaging confirmed extensive tumor recurrence with destruction of nasal structures and extension into adjacent tissues, significantly limiting therapeutic options. Due to advanced disease progression upon re-engagement in care, the patient ultimately succumbed to disease-related complications.
Outcomes Data: This case exemplifies the high recurrence risk associated with LTFU in nasal SCC. Research indicates that patients who disengage from follow-up care have a significantly higher likelihood of presenting with inoperable recurrences, reducing their chances of curative treatment. Factors such as lack of insurance, transportation barriers, and the psychosocial impact of facial disfigurement contribute to LTFU, emphasizing the need for proactive interventions to ensure continued post-treatment surveillance.

Conclusions: This case underscores the critical importance of adherence to follow-up care in preventing fatal recurrences of nasal SCC. The medical community must implement structured follow-up protocols, patient navigation programs, and multidisciplinary care strategies to address barriers to long-term oncologic surveillance. Without such interventions, preventable cancer recurrences will continue to result in unnecessary fatalities. Ensuring follow-up adherence is not merely a recommendation — it is a fundamental component of life-saving cancer care.
SCC patient lost to follow up s/p rhinectomySCC patient lost to follow up s/p rhinectomy