The impact of the multidisciplinary tumor board on head and neck cancer outcomes

Abstract

Objectives/Hypothesis Although the multidisciplinary tumor board (MTB) is accepted as best practice for the management of head and neck squamous cell carcinoma (HNSCC), there is limited evidence showing its impact on survival. Our goal was to investigate the impact of an MTB following the hiring of a fellowship‐trained head and neck surgeon and implementation of an MTB at our institution. We hypothesized that these changes would demonstrate an improvement in survival. Study Design Retrospective chart review. Methods A review of HNSCC treated at our institution between October 2006 and May 2015 was performed. The cohort was divided into pre‐MTB (October 2006–February 2011) and post‐MTB (February 2011–May 2015) cohorts. Patient demographics, cancer stage, and treatment outcomes were reviewed. Univariate, multivariate, and survival analysis were performed. Results The study included 224 patients, 98 in the pre‐MTB cohort and 126 in the post‐MTB cohort. Of total patients, 139 (62%) were black and 91 (40%) were on Medicaid or uninsured. Average follow‐up time was 2.8 years, and most cases were advanced stage (68%). On Kaplan‐Meier evaluation, overall survival and disease‐specific survival were significantly improved in the post‐MTB cohort compared with the pre‐MTB cohort, with a 5‐year disease‐specific survival of 52% vs. 75% (P = .003). A matched cohort analysis showed that the post‐MTB cohort had significantly lower risk of death (hazard ratio: 0.48). Conclusions Our study demonstrates that treatment of HNSCC by a dedicated multidisciplinary team results in improved survival. Multidisciplinary care should be considered best practice in the care of HNSCC. Level of Evidence 3b Laryngoscope, 130:946–950, 2020

Transition to a virtual multidisciplinary tumor board during the COVID‐19 pandemic: University of Pittsburgh experience

“…There is strong evidence to suggest that MDC implementation may improve pretreatment evaluation (dental, nutrition), 6 proper staging, 7,8 and appropriate timely treatment 6‐11 . It may also affect disease specific survival 11,12 and overall survival 10‐15 but this is controversial. As MDC usage has become more widespread, academic institutions are beginning to evaluate MDC quality measures with respect to guideline adherence and patient outcomes 13 .…”

Surge after the surge: Anticipating the increased volume and needs of patients with head and neck cancer after the peak in COVID‐19

“…Multidisciplinary care through a head and neck tumor board has been clearly shown to improve outcomes in patients with head and neck cancer. [16][17][18] During the COVID-19 pandemic, utilization of a multidisciplinary decision-making is of critical importance, especially when there is an influx of many patients during a time of limited resources and high risk of COVID-19 transmission. In some situations, surgical and nonsurgical treatment options may have similar outcomes.…”

Best Practice in Surgical Treatment of Malignant Head and Neck Tumors

“…He stated the need of an interdisciplinary education of head neck surgeons:" This is the only way that the future 'multidisciplinary team' will have not merely head and neck surgeons, but rather head and neck surgical oncologists as members; that is what I hope the guidelines come to reflect in years to come" (37). Recently Liu et al (38) demonstrated that multidisciplinary tumor boards have a positive impact on head and neck cancer patient outcome, but further literature addressing questions of best practice in this field is lacking.…”