Impact of Tumor Board Recommendations on Treatment Outcome for Locally Advanced Head and Neck Cancer

Abstract

Background/Aims: To identify physician selection factors in the treatment of locally advanced head and neck cancer and how treatment outcome is affected by Tumor Board recommendations. Methods: A retrospective analysis of 213 patients treated for locally advanced head and neck cancer in a single institution was performed. All treatments followed Tumor Board recommendations: 115 patients had chemotherapy and radiation, and 98 patients received postoperative radiation. Patient characteristics, treatment toxicity, locoregional control and survival between these two treat- ment groups were compared. Patient survival was compared with survival data reported in randomized studies of locally advanced head and neck cancer. Results: There were no differences in comorbidity factors, and T or N stages between the two groups. A statistically significant number of patients with oropharyngeal and oral cavity tumors had chemoradiation and postoperative radiation, respectively (p < 0.0001). Grade 3–4 toxicities during treatment were 48 and 87% for the postoperative radiation and chemoradiation groups, respectively (p = 0.0001). There were no differences in survival, locoregional recurrences and distant metastases between the two groups. Patient survival was comparable to survival rates reported by randomized studies of locally advanced head and neck cancer. Conclusion: Disease sites remained the key determining factor for treatment selection. Multidisciplinary approaches provided optimal treatment outcome for locally advanced head and neck cancer, with overall survival in these patients being comparable to that reported in randomized clinical trials.

Multidisciplinary Management of Cancer Patients: Chasing a Shadow or Real Value? An Overview of the Literature

“…A limited number of studies assessed impact of mccs on patient outcomes [4][5][6]15,23,29 . The common conclusion drawn was that multidisciplinary clinics and mdts are associated with improved survival.…”

Is it worth reorganising cancer services on the basis of multidisciplinary teams (MDTs)? A systematic review of the objectives and organisation of MDTs and their impact on patient outcomes

“…All studies concluded that a multidisciplinary setting resulted in improved patient outcomes in terms of diagnosis and/or treatment planning [14][15][16][18][19][20][21][22][25][26][27][28][29][31][32][33][35][36][37]40,42], improvements in survival [15,17,21,23,[28][29][30]36,39,41], patient satisfaction [24,31,38] and clinician satisfaction as a consequence of teamwork communication and cooperation [15,34]. Evidence of improved survival was found for colorectal [15,17,28,36], head and neck [29,41], breast [39], oesophageal [21] and lung [30] cancer.…”

“…The studies documented two motivating principles: firstly, MDTs ensure more appropriate treatment through a preoperative review of imaging and pathology results [19,20,22,25,26,40,42]; and secondly, a multidisciplinary approach guarantees the most up-todate treatment for all cancer patients seen at the facility or discussed online [16,18,21,23,32,33,35,[38][39][40][41]53]. Other clinical-based goals included improving patients' quality of life [24,32,42,[53][54][55] and setting up a structured followup care plan [53,[59][60][61].…”

“…A number of studies reflected a desire to involve patients actively in their care and promote greater understanding of the specific collaborative MDT intervention. Indeed, some expressly mentioned that the MDT rationale had been explained to the patient [23,24]. Treatment, toxicities, side effects, complications and information on second-and third-line treatments after recurrent disease were variously reported as having been discussed with patients before making decisions, sometimes by using written materials or by providing access to psychologists or social workers [18,20,23,38,42,52,53,56,58,59,61,64].…”

Multidisciplinary clinical approach to the management of head and neck cancer

“…Case presentation at HnN MDT affects and changes the clinical staging and therefore improves outcomes in a significant number of patients and improves quality of survival [19][20][21]. Because head and neck cancer is rare and complex, it has been suggested that advanced stage disease surgery should only be performed in high volume hospitals which will result in a shorter hospital stay, a better long-term survival and cure-rate [22][23][24].…”