Lead-time from diagnosis to start of radiation shortened by 44% for head and neck cancer when patients go through a multidisciplinary clinic.

Abstract

e16627 Background: Head and neck cancer (HNC) is a multidisciplinary condition. Multi-modality treatment is standard, especially the use of chemoradiation. Proper imaging (CT, MRI and PET), more accurate pathologic assessment and thoroughly tailored treatment plans that limits radiation fields and doses and take into consideration surgical options that minimize morbidity (endoscopic and robotic procedures) are essential. Furthermore, dental, swallowing, speech, nutritional, financial and social support are also cornerstones in this comprehensive approach. However, the most important function might be the role of the nurse navigator in order to offer true coordinated care for our patients. Within William Beaumont Oncology Network we initiated multi-disciplinary clinics for HNC in January 2010 in which our specialists meet the patients together after discussion at the tumor board to streamline management. Methods: In this initial analysis we studied 15 randomly chosen patients’ way through our health care system in 2009, and compared with 15 randomly chosen patients in 2010, after the initiation of the Multi-Disciplinary Clinic. All patients had biopsy verified HNC, the vast majority being squamous cell carcinomas, and were stage III or stage IV. The radiation techniques were unchanged during study and treating physicians remained the same as well. Results: The first group of patients that did not go through our multi-disciplinary clinic had a mean time of 59 days (range 4-156) from pathologic diagnosis to start of radiation. Corresponding mean time for patients going through the multi-disciplinary clinics was 33 days (range 18-86), a decrease of 44%. Conclusions: Coordinated care is of uttermost importance for patients with HNC. The complex treatment options, significant potential morbidities and complications along with complicated socio-economic conditions, underline the necessity of a comprehensive work-up for these patients. We show a significant decrease in time for management of HNC patients when a multi-disciplinary clinic is used in which specialists and a nurse navigator see the patients together.