Patterns of Multidisciplinary Care of Head and Neck Squamous Cell Carcinoma in Medicare Patients

Abstract

IMPORTANCE Multidisciplinary care (MDC) yields proven benefits for patients with cancer, although it may be underused in the complex management of head and neck squamous cell carcinoma (HNSCC).OBJECTIVE To characterize the patterns of MDC in the treatment of HNSCC among elderly patients in the US. DESIGN, SETTING, AND PARTICIPANTSThis nationwide, population-based, retrospective cohort study used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from January 1, 1991, to December 31, 2011, to identify patients 66 years or older diagnosed with head and neck cancer and determine the dates of diagnosis, oncology consultations, treatment initiation, and speech therapy evaluation in addition to MDC completion. Multidisciplinary care was defined in a stage-dependent manner: localized disease necessitated consultations with radiation and surgical oncologists, and advanced-stage disease also included a medical oncology consultation, all before definitive treatment. Data were analyzed between December 2016 and September 2020. MAIN OUTCOMES AND MEASURESRates of MDC across all subsites of head and neck cancer as measured by the presence of an evaluation for each oncologist on the MDC team and its effect on treatment initiation. RESULTSThis cohort study assessed 28 293 patients with HNSCC (mean [SD] age, 75.1 [6.6] years; 67% male; 87% White) from the SEER-Medicare linked database. The HNSCC subsites included larynx (40%), oral cavity (30%), oropharynx (21%), hypopharynx (7%), and nasopharynx (2%). Overall, the practice of MDC significantly increased over time, from 24% in 1991 to 52% in 2011 (P < .001). For patients with localized (stage 0-II) tumors, 60% received care in the multidisciplinary setting, whereas 28% of those with advanced-stage disease did. A total of 18 181 patients (64%) were treated with initial definitive nonsurgical therapy across all stages. Regardless of stage and subsite, few patients (2%) underwent evaluation by a speech-language pathologist before definitive therapy. Multidisciplinary care prolonged the time to initiation of definitive treatment by 11 days for localized disease and 10 days for advanced disease.CONCLUSIONS AND RELEVANCE This cohort study found that most elderly patients with localized HNSCC received MDC, whereas few patients with advanced-stage disease received such care, although a significant proportion received adjuvant therapy. Multidisciplinary care may prolong time to initiation of definitive treatment with an uncertain impact. Consultation with a speech-language pathologist before definitive therapy was rare.

The Multidisciplinary Team (MDT) in the Treatment of Head and Neck Cancer – A Single-institution Experience

“…It is important for the general state of the patient, the overall psychophysical status, influence on quality of life, and potential complications that tumors and their treatment can lead to, not only in the head and neck area. 21 This is corroborated by the study by Schorn et al which aimed to assess potential correlations between specific patient needs for care with regard to holistic rehabilitation, family/social support, economic needs, and their influence on health-related quality of life. This retrospective analysis included a total of 1359 patients.…”

Trends in the Implementation of Multidisciplinary Care in Patients With Head and Neck Cancer

“…With this model, patients should be armed with all necessary information to have a well-informed treatment plan in place by the conclusion of their visit. This version of an MDC experience is much different from how MDC was defined in the study by Hansen et al 1 How meaningful MDC is for tumors that clearly have a preferred treatment regimen is not entirely known, but it likely still has value. Multidisciplinary care becomes more important when there are multiple acceptable treatment options, such as with oropharyngeal and laryngeal cancers, and different availabilities of clinical trials.…”

“…With this model, patients should be armed with all necessary information to have a well-informed treatment plan in place by the conclusion of their visit. This version of an MDC experience is much different from how MDC was defined in the study by Hansen et al…”

“…Head and neck cancer care is complex and often requires coordination among multiple specialties in a timely fashion to provide optimal outcomes and patient satisfaction. In this issue, Hansen et al evaluate patterns of multidisciplinary care (MDC) in the treatment of head and neck squamous cell carcinoma (HNSCC) among 28 303 elderly patients in the US between 1991 and 2011 using Surveillance, Epidemiology, and End Results–Medicare linked data. The authors define MDC as evaluation by an otolaryngologist, oral surgeon, or head and neck surgeon and radiation oncologist for localized (ie, TMN stage 0-II) cancer and by a medical oncologist for advanced (ie, TMN stage III-IV cancer) before initiating definitive therapy.…”

A Principal Component of Quality of Life Measures Is Associated with Survival for Head and Neck Cancer Patients Treated with Radiation Therapy

“…Outcomes can vary significantly among HNC with human papilloma virus (HPV)-associated tumors of the oropharynx approaching a survival rate of 80–90%, yet locally advanced, HPV-negative cancers of the oropharynx and other subsites demonstrate an approximate 5-year survival of 50–60% [ 2 , 3 , 4 ]. Radiation therapy is considered one of the main treatment modalities for HNC and is utilized in over 60% of patients [ 5 ]. Regrettably, treatment for HNC is associated with considerable morbidity with a substantial impact on health-related quality of life (HRQOL) [ 6 ].…”