Head and neck cancer is the most common cancer in males and the fifth most common in females Dr Ayan Basu, Radiation Oncologist, HCG EKO Cancer Centre, Kolkata shares his insight on how a multi-disciplinary approach can provide an effective, timely and evidence-based management of these complex and heterogeneous tumours
Head and Neck cancer is the term used to describe different malignant tumours that develop in or around the throat, larynx, nose, sinuses and mouth. Most of these cancers are squamous cell carcinomas or cancers that begin in the lining of the larynx, throat, lips, mouth, nose and salivary glands.
According to a recent study conducted by the National Center for Biotechnology Information (NCBI), Head and Neck cancers in India accounted for 30 per cent of all cancers. It is the most common cancer in males and the fifth most common in females. In India, 60 to 80 per cent of patients present with advanced disease as compared to 40 per cent in developed countries.
Head and Neck tumours are typically characterised by incidences reported in the elderly and a strong correlation is built with chronic exposure to risk factors such as smoking and alcohol abuse. Nevertheless, around five per cent of patients suffering from head and neck cancer are diagnosed before they reach the age of 45 years. The incidence in this subgroup appears to be consistently growing in recent years.
The concept of multidisciplinary management
A multi-disciplinary approach is where clinicians from different specialties collaborate and interact as a team in order to provide effective, timely and evidence-based management of these complex and heterogeneous tumours. The core members of the multi-disciplinary team include head and neck surgeons, radiation and medical oncologists, pathologists, radiologists, swallow and speech pathologists, nurse specialists and also dieticians. The multi-disciplinary approach primarily focuses on group decision making and patient-centredness.
Importance and necessity of the multidisciplinary approach in the treatment of head and neck cancer
A multi-disciplinary approach is critical for patients as it improves the survival period, and in turn, benefits doctors to make better decisions. Several disciplines are involved in providing optimal supportive care to head and neck cancer patients. Along with this, the MDT approach facilitates clear communication between the specialists and the patient, which positively impacts the latter’s confidence in the diagnosis and treatment.
Ajith (name changed), a 59-year-old man and a pharmacist by profession, approached HCG EKO Cancer Centre, Kolkata complaining of severe pain and swelling on his right cheek from the last three-to-four months, which was gradually progressing. After several examinations, it was found that the patient was suffering from non-metastatic spindle cell neoplasm, a form of soft tissue sarcoma. These soft tissue sarcomas of the head and neck region are relatively uncommon. It poses a unique therapeutic challenge due to its inherent aggressive nature. This type of cancer is most prevalent amongst men. It is essential to treat it immediately, or it can spread to the mouth, tongue and other distant body parts. The earlier the cancer is diagnosed, the easier it is to treat it, successfully. A multidisciplinary team (MDT) approach treatment was recommended, as this was a complicated case.
The multi-disciplinary team of doctors decided to go ahead with an Upfront Radical Surgery. He underwent wide local excision along with right-sided neck dissection and reconstruction. Post-operation, the specimens were sent for histopathology examination, which reported a high-grade soft tissue sarcoma. After this surgery, the MDT team decided to proceed with adjuvant radiotherapy. The onco-specialists planned for helical tomotherapy on the Radixact X9 with shrinking volumes and increasing doses. With tolerable radiation toxicity, the patient completed his treatment successfully. This patient was also suffering from grade-two mucositis and grade-two skin pigmentation which were resolved in six weeks.
Three months after the radiotherapy, a PET-CT scan was done to assess the response and no irregularities were found. The patient had recovered completely and no recurrence of the tumour was recorded.
Improving outcomes with a multidisciplinary approach
The above case stands as an example of how multi-disciplinary teams have the potential to improve the quality of life and increase the survival rate for cancer patients. In reference to such complicated cases, a democratic forum for open and constructive discussions is essential. The multi-disciplinary team of doctors ensures that every aspect of side effects arising from cancer care is adequately addressed. Several disciplines are involved in providing optimal supportive care to head and neck cancer patients.
The integration of all the departments and professionals involved in the treatment of a specific type of cancer ensures full and continued support to patients during diagnosis, treatment and follow-up periods and it is perceived positively by most patients.
In the absence of a multi-disciplinary approach, patients have to take time off for multiple appointments, and when they meet physicians, different opinions are shared, which can be extremely overwhelming for the patients. In addition, most patients are not seen by nutritionists, mind and body psychologists or pain specialists, whose intervention is paramount for successful cancer treatment, faster recovery and the overall well-being of the patients.
This discussion with multiple providers in real-time allows a consensus to come to life and gives the patient confidence in their treatment plan. It was out of witnessing such situations that the multi-disciplinary approach was initiated. This patient-centric initiative is crucial to address all of the patient’s needs in one session.