Multidisciplinary Care in Head and Neck Cancer

Neck dissection for squamous cell carcinoma of the head and neck

OBJECTIVES

To investigate the successes and failures of 172 patients receiving neck dissections for squamous cell carcinoma (SCC) managed through a multidisciplinary head and neck clinic and to observe factors in predicting failure (death with head and neck cancer or local regional recurrence) or local regional recurrence alone.

STUDY DESIGN

A retrospective, 14-year surgical audit.

METHODS

The information from patient medical records was correlated with that of a database. Multivariate analysis was performed with the use of a logistic regression model.

RESULTS

The most common site for head and neck SCC was the oral cavity (42%), with 17% of patients having tumors of unknown primary site. The disease-free survival probability was 76.7% at five years. Patients who were older at neck dissection, were nonsmokers, or who did not have radiotherapy to the primary site were more likely to die with head and neck cancer or to have local regional recurrence (P < 0.1). Patients with more radical neck dissections did not have better survival or recurrence outcomes. Lymphatic invasion appears to be the only important factor in predicting local regional recurrence alone (P = 0.1), of which 67% occurred within the first postoperative year.

CONCLUSIONS

Patients with smoking-related SCC are likely to have a less aggressive disease. Adjuvant radiotherapy plays an important role in the treatment of patients with head and neck SCC. Follow-up, especially within the first postoperative year, is essential in managing head and neck SCC. Head and neck surgeons can confidently continue their practice away from more radical neck dissections.

Tumour boards/multidisciplinary head and neck cancer meetings: are they of value to patients, treating staff or a political additional drain on healthcare resources?

PURPOSE OF REVIEW

This article reviews the literature on the management of head and neck cancer using multidisciplinary team meetings as well as addressing the question of whether or not this organization is of benefit to the patients and treating staff and if it is cost efficient.

RECENT FINDINGS

The multidisciplinary team has developed because of the complexity of clinical workup and treatment of head and neck cancer for which no single physician can claim to master all the training and skills necessary to treat the patients. The multidisciplinary team ensures that the professional efforts are coordinated and timely, thus ensuring the best results for patients. The multidisciplinary team usually involves a centralization of care with specialization, which benefits the outcome of treatment as well as enabling the development of clinical pathways to minimize complications, and improving on cost effectiveness.

SUMMARY

The multidisciplinary team has become more and more an integral part of the clinical pathway for a patient with head and neck cancer in many European countries. This is cost effective and benefits patient outcomes.

Critical care of the head and neck patient

The patient with head and neck disease has several peculiarities that need to be recognized for the treating team to offer optimal care. These arise from the primary disorders (eg, head and neck cancer or injuries) and the morbidity they might cause, the associated comorbidities, and the possible complications of treatment. A team approach involving the surgeon, the intensivist, and other caretaking personnel is essential to achieve high-quality care and ensure the best results possible.