Decision making in head and neck cancer care

Davies, Louise; Rhodes, Lorna A.; Grossman, David C.; Rosenberg, Marie Claire; Stevens, David P.

doi:10.1002/lary.21036

Cited by 31 publications

(32 citation statements)

References 24 publications

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“…For example, up to 20 % of patients would accept a lesser chance of cure to avoid a laryngectomy and to keep their normal voice [ 3 , 4 ]. Hence, decisions on head and neck cancer treatment are widely recognized as being difficult [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Noncompliance to guidelines in head and neck cancer treatment; associated factors for both patient and physician

et al. 2015

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BackgroundDecisions on head and neck squamous cell carcinoma (HNSCC) treatment are widely recognized as being difficult, due to high morbidity, often involving vital functions. Some patients may therefore decline standard, curative treatment. In addition doctors may propose alternative, nonstandard treatments. Little attention is devoted, both in literature and in daily practice, to understanding why and when HNSCC patients or their physicians decline standard, curative treatment modalities. Our objective is to determine factors associated with noncompliance in head and neck cancer treatment for both patients and physicians and to assess the influence of patient compliance on prognosis.MethodsWe did a retrospective study based on the medical records of 829 patients with primary HNSCC, who were eligible for curative treatment and referred to our hospital between 2010 and 2012. We analyzed treatment choice and reasons for nonstandard treatment decisions, survival, age, gender, social network, tumor site, cTNM classification, and comorbidity (ACE27). Multivariate analysis using logistic regression methods was performed to determine predictive factors associated with non-standard treatment following physician or patient decision. To gain insight in survival of the different groups of patients, we applied a Cox regression analysis. After checking the proportional hazards assumption for each variable, we adjusted the survival analysis for gender, age, tumor site, tumor stage, comorbidity and a history of having a prior tumor.Results17 % of all patients with a primary HNSCC did not receive standard curative treatment, either due to nonstandard treatment advice (10 %) or due to the patient choosing an alternative (7 %). A further 3 % of all patients refused any type of therapy, even though they were considered eligible for curative treatment. Elderliness, single marital status, female gender, high tumor stage and severe comorbidity are predictive factors. Patients declining standard treatment have a lower overall 3-year survival (34 % vs. 70 %).ConclusionsPredictive factors for nonstandard treatment decisions in head and neck cancer treatment differed between the treating physician and the patient. Patients who received nonstandard treatment had a lower overall 3-year survival. These findings should be taken into account when counselling patients in whom nonstandard treatment is considered.

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Section: Introductionmentioning

confidence: 99%

Noncompliance to guidelines in head and neck cancer treatment; associated factors for both patient and physician

et al. 2015

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“…Qualitative research has contributed to understandings of how people with a life‐threatening illness make sense of the factors that are important to them when they make decisions, why there may be interactional difficulties in the consultation and how they make sense of being asked to participate in decisions . For example, in a qualitative interview study of people at the end of life in three European countries, patients noted that doctors sometimes only gave information about the treatments that they preferred without discussing the ‘consequences of other actions’ .…”

Section: Introductionmentioning

confidence: 99%

Barriers to shared decisions in the most serious of cancers: a qualitative study of patients with pancreatic cancer treated in the UK

Ziébland

Chapple

Evans

2014

Health Expectations

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“…A seminal study in the head and neck literature demonstrated through grounded theory analysis that head and neck patients, who are often in considerable pain and distress, do not make decisions according to the conventional shared decision‐making model. Patients focus on a “decision to do something” more than choosing a specific treatment and they rely heavily on a trust relationship with their physician . This study also noted that head and neck patients tend to move sequentially through different consulting specialists who may each offer a form of index treatment.…”

Section: Medical Decision Makingmentioning

confidence: 82%

Concurrent palliative care in the surgical management of head and neck cancer

McCammon

2019

Journal of Surgical Oncology

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Head and neck cancer affects vital functions of speech, swallowing, breathing, and appearance. Overall survival remains poor and symptom burden is high for both patients with incurable disease at the end of life and for long-term survivors. Early and concurrent palliative care helps guide treatment decision making and support quality of life during and after treatment. Both narrative competence and directive counsel can affect the concordance of patient goals and tolerance of treatment and outcomes. K E Y W O R D S decisional regret, directive counsel, narrative competence, supportive care, survivorship J Surg Oncol. 2019;120:78-84. wileyonlinelibrary.com/journal/jso

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Decision making in head and neck cancer care

Cited by 31 publications

References 24 publications

Noncompliance to guidelines in head and neck cancer treatment; associated factors for both patient and physician

Noncompliance to guidelines in head and neck cancer treatment; associated factors for both patient and physician

Barriers to shared decisions in the most serious of cancers: a qualitative study of patients with pancreatic cancer treated in the UK

Concurrent palliative care in the surgical management of head and neck cancer

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