Streamlined Multidisciplinary Approach Improves Efficiency in Head and Neck Cancer

11/09/17

The use of a multidisciplinary management approach to head and neck cancer treatment increased the efficiency and level of care patients received, according to research published in JAMA Otolaryngology Head & Neck Surgery (online October 26, 2017; doi:10.1001/jamaoto.2017.1855).

The treatment of head and neck cancers involves coordination among multiple specialists, including surgeons, medical oncologists, otolaryngologists, and radiation oncologists. Researchers led by Melanie Townsend, MD, otolaryngologist at Washington University in St. Louis, hypothesized that a single-appointment, multidisciplinary clinic could reduce treatment delays and improve overall care.

Dr Townsend and colleagues performed a retrospective cohort study using data from patients treated in a traditional multi-day clinic (n = 73) or a single-day, multidisciplinary clinic (n = 68). The study population included patients with squamous cell carcinoma of the oropharynx, hypopharynx, sinonasal tract, and larynx.

Patients treated in the multidisciplinary clinic experienced fewer delays greater than 30 days between referral and treatment initiation (41% vs 59%), as well as shorter wait times between first appointment and treatment initiation (10% vs 23%).

Researchers further observed significant differences in actual median days in favor of the multidisciplinary approach, after excluding patients in the multi-disciplinary cohort who saw only a surgeon after treatment initiation (28 days vs 35 days; median difference, -5 days; 95% confidence interval, -11 to -1).

“It was noted during analysis that a group of 23 patients in the traditional cohort who were treated with upfront surgery did not see medical or radiation oncology clinicians until after surgery, even though nonsurgical management was an alternative primary modality or was indicated in the adjuvant setting,” Dr Townsend and colleagues wrote.

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The researchers are planning further studies to determine whether a multidisciplinary management approach impacts patient survival.

“We believe that this approach facilitates improved efficiency and completeness of care,” the researchers wrote.Cameron Kelsall