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Evaluating a Care Team

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The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers recommend that patients receive treatment at a high-volume center from a multidisciplinary team.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. Ideally, the team members will have expertise in head and neck cancer. Because head and neck cancer is a relatively rare type of cancer (3 percent of all cancer cases in the U.S.), there are likely to be few locations with a cancer care team that has this expertise.2Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501.

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Criteria for assessment

Researchers have evaluated the characteristics of either physicians and/or health care facilities that affect outcomes. There are limitations to these studies; the researchers who did these studies often evaluated patients with different types of cancer and did not all look at the same characteristics.

Characteristics associated with physicians that contributed to improved outcomes included:

  • Surgeons who perform a high volume of surgeries versus a low volume3, Ko CY, Chang JT, Chaudhry S, Kominski G. Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Surgery. 2002 Aug;132(2):268-73. 4, Karanicolas PJ, Dubois L, Colquhoun PH, Swallow CJ, Walter SD, Guyatt GH. The more the better?: the impact of surgeon and hospital volume on in-hospital mortality following colorectal resection. Ann Surg. 2009 Jun;249(6):954-9.5Billingsley KG, Morris AM, Dominitz JA, et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg. 2007 Jan;142(1):23-31; discussion 32.
  • Specialists with expertise in the type of cancer versus generalists6Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000 Jun;18(11):2327-40.

Characteristics associated with hospitals that contributed to improved outcomes included:

  • Hospitals that performed a high volume of surgeries had improved patient survival rates of 19 to 60 percent compared to hospitals that performed a low volume of surgeries.6Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000 Jun;18(11):2327-40.
  • Hospitals that provided other specialized services were more successful in reducing treatment side effects.5Billingsley KG, Morris AM, Dominitz JA, et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg. 2007 Jan;142(1):23-31; discussion 32.
  • National Cancer Institute (NCI) hospitals had lower mortality rates versus non-NCI hospitals.7Friese CR, Earle CC, Silber JH, Aiken LH. Hospital characteristics, clinical severity, and outcomes for surgical oncology patients. Surgery. 2010 May;147(5):602-9.

Treatment can also take place at NCI-designated centers.These centers offer the following advantages: multidisciplinary teams; access to clinical trials, which may be ideal for people with advanced head and neck cancer who have few treatment options; and specialization in rare cancers.8National Cancer Institute Website. Accessed at http://www.cancer.gov/dictionary on February 18, 2013.

In summary, clinicians and health care centers that can provide the following improve outcomes:

  • Multidisciplinary teams1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Clinicians and/or a hospital center with a specialty in head and neck cancer1, Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.6Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000 Jun;18(11):2327-40.
  • Health care professionals and/or hospitals that perform high numbers of particular medical procedures3, Ko CY, Chang JT, Chaudhry S, Kominski G. Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Surgery. 2002 Aug;132(2):268-73. 4, Karanicolas PJ, Dubois L, Colquhoun PH, Swallow CJ, Walter SD, Guyatt GH. The more the better?: the impact of surgeon and hospital volume on in-hospital mortality following colorectal resection. Ann Surg. 2009 Jun;249(6):954-9.5, Billingsley KG, Morris AM, Dominitz JA, et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg. 2007 Jan;142(1):23-31; discussion 32. 6Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000 Jun;18(11):2327-40.
  • NCI-designated personnel or facilities7Friese CR, Earle CC, Silber JH, Aiken LH. Hospital characteristics, clinical severity, and outcomes for surgical oncology patients. Surgery. 2010 May;147(5):602-9.

Even though experts recommend these criteria to select a specialist or health care center, it’s important to also factor in criteria important to you and your loved one. For example, receiving treatment at a location close to home, friends and family is important to many patients.

I was never scared, and I really think a lot of that had to do with the confidence I had in my surgeon.Tony L. (oral cancer survivor)

References

1 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

2 Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501.

3 Ko CY, Chang JT, Chaudhry S, Kominski G. Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Surgery. 2002 Aug;132(2):268-73.

4 Karanicolas PJ, Dubois L, Colquhoun PH, Swallow CJ, Walter SD, Guyatt GH. The more the better?: the impact of surgeon and hospital volume on in-hospital mortality following colorectal resection. Ann Surg. 2009 Jun;249(6):954-9.

5 Billingsley KG, Morris AM, Dominitz JA, et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg. 2007 Jan;142(1):23-31; discussion 32.

6 Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000 Jun;18(11):2327-40.

7 Friese CR, Earle CC, Silber JH, Aiken LH. Hospital characteristics, clinical severity, and outcomes for surgical oncology patients. Surgery. 2010 May;147(5):602-9.

8 National Cancer Institute Website. Accessed at http://www.cancer.gov/dictionary on February 18, 2013.