Description
Calman-Head & Neck Oncology
The Challenge
“Everybody should be able to manage patients with head and neck cancer” whether they are able to is the debate! Tumours of the larynx are by far the most common primary site seen by ORL-HNS with occasion to see tumours of the oral cavity and oropharynx. Other tumour sites such as parotid, thyroid, etc, will depend on the local referral practice of the primary care physicians. In the UK currently most patients who present with a primary tumour of the larynx and hypopharynx irrespective of the stage are referred for radiotherapy.1 In early laryngeal cancers, the cure rate should be over 90%, whereas only 10-15% of hypopharynx cancers treated by radiotherapy are alive at 5 years.
A New Framework
The Calman/Hine Report2 on “a policy framework for commissioning Cancer Services” recognises that common cancers would be managed at the Unit level but cancers which occur less frequently would be treated in the Cancer Centres. Head and Neck Cancer in the UK is one of these uncommon cancers with this tumour site being 8th in frequency for men and 16th for women. It is expected that all ORL-HNS specialists who express an interest in the diagnosis and management of patients who present with a tumour of the Head and Heck will be active members of the British Association of Head and Neck Oncologists (BAHNO).
“Policy Report”
Two subcommittees have now reported to the BAHNO on their findings. One group on the “Provision and Quality Assurance for Head and Neck Cancer Care in the UK”3 concludes that there is “unsatisfactory fragmentation of patient management between a large number of different specialities”. It also recommends that there should be “functional centralisation of expertise and resources… to ensure high quality care, improved survival rates and enhanced quality of life”.
The second report4 viewed the future development of Head and Neck Cancer Services and states that “centres for teaching and research must have a large catchment population” and that there will be “less head and neck cancer teaching and research centres than treatment centres.” One recommendation is that Level 3 training in Head and Neck Cancer would be following completion of CCST in an extra year and such experience would be offered to all allied surgical trainees involved in patient care.
Selection of Cancer Centres
Currently Head and Neck Cancer Centres are being selected on the basis of having radiotherapy available in close proximity to a surgical/clinical unit. Surely the centre should be selected on the “track record” of the personnel who provide the care rather than the hardware available? It may be that there currently is no gross/crude 5 year patient survival data available in many of the proposed Head and Neck Cancer Centres – surely this is unacceptable.
How many currently dedicated people in ORL-HNS can you name who provide a more than passing interest in providing a service for patients who suffer a Head and Neck Cancer? Are you or do you know somebody who is willing or able to provide a quality service locally, irrespective of their clinical specialty? Only departments or groups of people who do or are willing to commit themselves to dedicate the majority of their working week to provide care and research into the aetiology, management and analysis of patient outcomes should be “recognised” as suitable for the provision of care for patients who suffer Head and Neck Cancer.
Conclusion
It therefore would appear that the “writing is on the wall” for the “dabbler” in Head and Neck Oncology in the UK.5 This specialty should recognise this fact sooner rather than later, and in order to maintain the specialty of ORL-HNS domination in Head and Neck Surgery, patients should be referred to their own local ORL-HNS specialist.
References
1. Bradley, P.J. “A Survey of Current Management of Laryngeal & Hypopharyngeal Cancer.” J. Roy.C.Surg.Ed 1989; 34: 187-200.
2. Calman, K., Hine, D. “ A Policy Framework for Commissioning Cancer Services.” Department of Health. April 1995.
3. Glaholm, J ( Chairman) Provision and Quality Assurance for Head and Neck Cancer Care in the United Kingdom. BAHNO 1996.
4. Jones, A.S ( Chairman) Report of the Education and Research Committee. BAHNO 1997.
5. Lore, J, Dabbling in Head and Neck Oncology. Arch Otolaryngology 1987; 113: 321- 325.
