Management of cancers of the head and neck in the United Kingdom: questionnaire survey of consultantsBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7122.1589 (Published 13 December 1997) Cite this as: BMJ 1997;315:1589
- Dympna Edwards, research fellowa (, )
- N W Johnson, heada,
- D Cooper, headb,
- K A A S Warnakulasuriya, senior lecturera
- a Royal College of Surgeons Department of Dental Sciences/Department of Oral Medicine and Pathology, King's College School of Medicine and Dentistry, The Dental School, London SE5 9RW
- b Computer Information Centre, King's College School of Medicine and Dentistry, Western Education Centre, London SE5 9DJ
- Correspondence to: Dr D Edwards Bedfordshire Health Authority, Charter House, Luton LU1 2PL
- Accepted 7 July 1997
Cancers of the upper aerodigestive tract—that is, of the head and neck and excluding lymphomas—present a number of challenges in implementing the changes recommended by the Expert Advisory Group on Cancer Services.1 As head and neck cancers are heterogeneous and occur at several sites they are managed by several disciplines. Treatment for these cancers may form a small part of the caseload of each of these disciplines, making it difficult for specialists to develop expertise in this area.2
We report on the current provision of services for the treatment of head and neck cancers in the United Kingdom.
Subjects, methods, and results
From April to June 1996 a questionnaire was sent to consultant members of specialist associations. These associations included otolaryngologists, maxillofacial and plastic surgeons, and medical and clinical oncologists. The questionnaire requested information on the management, facilities, and types and numbers of cases of head and neck cancers seen by each consultant.
One thousand and forty one (74%) consultants responded; 122 (12%) did not treat head and neck cancers and were excluded from further analysis. Of the 919 respondents who did treat head and neck cancers, 515 (56%) said that they routinely assessed patients in joint clinics, 193 (21%) within their specialties in liaison with another specialty, and 211 (23%) within their specialty alone. Only 37 (4%) consultants used any standardised method of collecting patient information and 129 (14%) said that they did not routinely record the clinical stage of tumours in the patient's notes. Three hundred and eighty one and 322 consultants reported no access to nurse specialists or counselling services (40% and 35% respectively).
The caseload of each consultant was recorded for each anatomical site—for example, lip, mouth, and larynx. The 919 consultants treat the 6500 new cases of cancer per year in the United Kingdom; less than 10 cases per consultant, even allowing for joint management. Less than half of the consultants treated more than 10 cases a year at any anatomical site (1). The consultants who treated more cases at any one site were also more likely to record the clinical stage of the tumour and to receive most of their referrals from hospital colleagues (P<0.0001).
Although there are inherent problems with self reporting questionnaires this study provides scarce information on the management of head and neck cancers in the United Kingdom. The treatment of these cancers is widely spread between individual consultants, disciplines, and provider units. A reduction in the number of consultants dealing with head and neck cancers would have implications for training and staffing. Only five to six new surgical consultants in oncology are estimated to be needed each year, but 57 surgeons are currently being accredited in the United Kingdom, all of whom will be able to deal with cancers of the head and neck.3
A team approach to the management of head and neck cancers has long been recommended4 but is practised by only half of consultants. The proportion of consultants not recording the clinical stage of the tumour makes any systematic audit of outcomes impossible. Given the psychosocial impact of cancer and its treatment,5 access to specialist nursing and counselling services would need to be ensured when changes are made to oncology services.
We thank the consultants who participated. We also thank the British Association of Otolaryngologists Head and Neck Surgeons, the British Association of Oral and Maxillofacial Surgeons, the British Association of Plastic Surgeons, the British Association of Head and Neck Oncologists, and the Cancer Research Campaign's clinical trials centre.
Funding: Department of Dental Sciences, Royal College of Surgeons.
Conflict of interest: None.