Close

Evaluating Your Cancer Care Team

DThe NCCN Guidelines® for Head and Neck Cancers recommend that patients receive treatment from multidisciplinary teams; ideally, the team members will specialize and have expertise in head and neck cancer.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. Head and neck cancer is a relatively rare type of cancer; head and neck cancer comprises only 3 percent of all cancer types in the United States.5 Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501.

Several studies have evaluated the characteristics of either physicians and/or health care facilities to affect outcomes. These studies have limitations: the studies were done using patients with different types of cancer and all studies did not evaluate the same characteristics.

Characteristics associated with physicians that contributed to improved outcomes were as follows:

  • Performing a high volume of surgeries versus a low volume6, 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. 7, 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):954-9.8 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.
  • Specialists with expertise in the type of cancer versus generalists9 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.

Characteristics associated with hospitals that contributed to improved outcomes were as follows:

  • 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.9 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.
  • Hospitals that provided other specialized services had an improved reduction of treatment side effects.8 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.
  • National Cancer Institute (NCI) hospitals had lower mortality rates versus non-NCI hospitals.10 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.

Treatment can also occur at NCI-designated centers.11 National Cancer Institute Website. Accessed at http://www.cancer.gov/dictionary on February 18, 2013. These centers offer the following advantages: multidisciplinary teams; access to clinical trials, which may be ideal for patients with very advanced head and neck cancer who have few treatment options; and specialization in rare cancers.11 National Cancer Institute Website. Accessed at http://www.cancer.gov/dictionary on February 18, 2013.

In summary, you may want to reflect on whether the following characteristics in a doctor and/or hospital are important to you. If so, do the research to see if the cancer treatment team and facility meets your criteria. Which of the following are important to you?

  • Having a multidisciplinary team
  • Having clinicians and/or a hospital center with a specialty in head and neck cancer
  • Health care professionals and/or hospitals that perform high numbers of particular medical procedures
  • The hospital or center is NCI-designated
  • Receiving treatment at a location near your home, friends and family
http://vimeo.com/64108654
I would recommend getting one or two or three more opinions, because that can truly change the outcome long-term. No matter what kind of cancer you’re diagnosed with, it’s a very long process and a very grueling process. And there are options. Bridget D. (mother of a neuroblastoma survivor)

References

1 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

2 Gaziano JE. Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9.

3 Chen H-C, Evans KFK, Salgado CJ, Mardini S. Methods of voice reconstruction. Seminars in Plastic Surgery. 2010:227-232.

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

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

6 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.

7 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.

8 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.

9 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.

10 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.

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

12 Hoffman B. Cancer survivors at work: a generation of progress. CA Cancer J Clin. 2005 Sep-Oct;55(5):271-80.