Patients with head or neck cancer should be treated at specialist centresBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7477.1257 (Published 25 November 2004) Cite this as: BMJ 2004;329:1257
The National Institute for Clinical Excellence (NICE) has issued guidelines on the treatment of patients with rare cancers of the head and neck. The guidelines, based on research conducted by the Centre for Reviews and Dissemination, advise that treatment should be centred at specialised cancer centres serving populations of over a million, where multidisciplinary teams will be responsible for all stages of the treatment process, including diagnosis and rehabilitation.
Head and neck cancers are not common and encompasses a range of conditions located at some 30 sites around the head and neck. Some, such as mouth and lip cancer, are more common; others, such as cancer of the salivary glands, result in only a few hundred registrations per year. Nevertheless, together these cancers are responsible for 2700 deaths a year in England and Wales—and as Professor Peter Littlejohns, clinical director at NICE, pointed out, the effects of treatment can be severe.
“Head and neck cancers can have devastating effects on the lives of patients,” said Professor Littlejohns. “The treatment can be disfiguring and often makes normal speech and eating impossible. For health services, head and neck cancers present particular challenges because of the variety of professional disciplines involved in caring for patients and the relatively sparse geographical distribution of patients requiring specialised forms of therapy or support.”
Cancer centres, it is hoped, will be able to bring together carers with the requisite range of expertise. Speech therapists, counsellors, and dietitians, as well as primary care staff, will have a part to play in rehabilitation. There is evidence that laryngectomy patients benefit from the interventions of a speech therapist, and a qualitative study has indicated that many patients feel they would benefit from counselling but are not always offered this service presently.
It is hoped that the rationalisation of cancer treatment will also improve its effectiveness in saving patients' lives. The research carried out by the Centre for Reviews and Dissemination indicates that staff members who deal with a high volume of cases are able to give more effective care, with a lower incidence of complication, death, and recurrence.
Early diagnosis has been identified as a major factor in ensuring the success of treatment. Patients with a diagnosis of late stage disease are far less likely to be successfully treated, and although a Brazilian study estimates that only around 13% of delays in the referral process are caused by health professionals, the centre suggests that the introduction of interventions designed to raise awareness of head and neck cancer among doctors, dentists, and nurses could be beneficial.
Julie Hoole, a Macmillan head and neck nurse specialist, said: “The guidance gives a structure and framework to services, ensuring that wherever a patient lives or receives treatment it is of a uniformly high standard.”
The guidance can be found at http://www.nice.org.uk/