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Comparative Study
. 2017 Dec 1;143(12):1213-1219.
doi: 10.1001/jamaoto.2017.1855.

Multidisciplinary Clinic Management of Head and Neck Cancer

Melanie Townsend  1 , Dorina Kallogjeri  1 , Nicholas Scott-Wittenborn  1 , Katherine Gerull  1 , Stacy Jansen  1 , Brian Nussenbaum  1
Affiliations
Comparative Study

Multidisciplinary Clinic Management of Head and Neck Cancer

Melanie Townsend et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: Contemporary management of head and neck cancer involves professionals from multiple specializations. Streamlined care that reduces delays yet allows for comprehensive evaluation is needed.

Objective: To evaluate a single-day, single-appointment, multidisciplinary head and neck clinic model for reduction in treatment delay and comprehensiveness of care.

Design, Setting, and Participants: A retrospective cohort analysis was conducted from June 1, 2015, to July 31, 2016, of outpatients at a single, academic medical center.

All eligible outpatients seen in either the multiple-appointment, traditional clinic (n = 73) or the single-day multidisciplinary clinic (MDC) (n = 68) were included. Patients with new squamous cell carcinoma of the oropharynx, hypopharynx, sinonasal tract, and larynx, along with any mucosal site recurrence were eligible for the study.

Main Outcomes and Measures: Primary outcomes were delays between tertiary clinic referral or first appointment and treatment initiation in the MDC compared with the traditional clinic. Secondary outcomes were complete evaluations prior to treatment, enrollment in trials and registries, and rate of patient leak, defined as initiating therapy and then transferring to another center before completion. Outcome selection and hypothesis generation were performed a priori.

Results: Patient factors and tumor characteristics were similar between the traditional clinic cohort (19 women and 54 men; mean [SD] age, 64.0 [10.2] years) and the MDC cohort (8 women and 60 men; mean [SD] age, 61.0 [8.9] years). The MDC cohort had significantly fewer instances of delay greater than 30 days from referral to treatment initiation (28 [41%] vs 43 [59%]) and first appointment to treatment initiation (7 [10%] vs 17 [23%]). Actual median days in these categories were significantly different between the 2 clinic types after the patients in the traditional clinic who saw only a surgeon before treatment initiation were excluded (MDC, 28 days vs traditional, 35 days; median difference, –5 days; 95% CI, –11 to –1).

Conclusions and Relevance: Coordination of the management of head and neck cancer is complex. Treatment is time sensitive, and frequently clinician resources are limited. This MDC model was associated with improved efficiency and completeness of care.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures

Figure 1.
Figure 1.. Median Days From Referral and First Appointment to Treatment Initiation Compared Between Cohorts
A, Full cohorts. B, Modified traditional cohort and multidisciplinary clinic (MDC). Upper and lower bounds of boxes represent upper and lower quartiles. Horizontal line represents median value, the lower vertical line is the lowest quartile, and the upper vertical line is the highest quartile. Outliers are shown as circles above upper bounds.
Figure 2.
Figure 2.. Number of Cases Greater Than 30 Days in the Multidisciplinary Clinic (MDC) vs Traditional Clinic
A, Delayed patients from referral to treatment initiation. B, Delayed patients from first appointment to treatment initiation.
See this image and copyright information in PMC

Comment in

References

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