Patient navigation as an equity intervention in head and neck cancer: Perspectives from a geocoded EMR cohort and qualitative insights from frontline navigators

Background: In head and neck cancer (HNC), shorter time from surgery to post-operative radiation therapy (PORT) is associated with survival and improved local control. However, delays are common and distributed unevenly, reflecting social determinants of health (SDOH) such as insurance, transportation, language, and housing and food instability. Patient Navigation has been demonstrated to improve screening, follow up, and appointment adherence in breast, lung, and colorectal cancers; however, rigorous evaluations specific to HNC patient navigation and PORT timelines remain extremely limited. This mixed methods study explores the lived experiences and perceived impact of navigators working within a tertiary academic Head and Neck surgical center. Methods: This concurrent mixed method study includes a quantitative arm and a quantitative interview arm. The quantitative arm utilizes a curated dataset with prespecified inclusion/exclusion criteria with the primary aim of describing baseline disparities in PORT timeliness pre-and-post initiation of the Patient Navigation HNC program and the secondary aims assessing 90-day post-operative emergency room visits and one year survival. Multivariable regression and time-to-event analysis will adjust for clinical factors and SDOH covariates. The qualitative arm comprises semi-structured interviews with all employed Head and Neck Cancer Patient Navigators (PNs). Analysis was conducted utilizing an inductive thematic approach. Interviews were then appraised using a structured three-domain evaluation framework. Results: Four overarching themes emerged from the conversations: (1) Relational coordination and patient advocacy (2) Incremental process improvement (3) Systematic Barriers and Resource Constraints (4) Vision for program growth. Navigator composite scores ranged from 6-8 of 9, reflecting strong engagement in patient-centered interventions and iterative workflow improvements. For the quantitative arm we will report (1) distributions of time to PORT across SDOH strata (2) adjusted effect estimates for PN on timeliness and adherence, and (3) themes mapping structural and process barriers to delays. Mixed methods integration will yield targets for intervention and measurable Patient Navigator performance indicators. Conclusions: By pairing robust analytics with Patient Navigator perspectives, this study will clarify if and how patient navigation reduces PORT delays in HNC, define SDOH-responsive metrics for quality improvement of Patient Navigation programs, and inform scalable implementation to improve both oncologic and equity outcomes.