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Invited Commentary
October 22, 2020

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

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
  • 2Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
JAMA Otolaryngol Head Neck Surg. 2020;146(12):1146-1148. doi:10.1001/jamaoto.2020.3497

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 al1 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. The aims of the study were to evaluate adherence to MDC and the association between MDC and the time to initiate definitive treatment, which is known to impact survival.2,3 The authors found that MDC use continued to increase during the study period, with more than half of patients receiving MDC in 2011. Most elderly patients with localized HNSCC fulfilled the authors’ definition of MDC, but few patients with advanced-stage met the criteria. Patients were more likely to receive MDC if they had localized disease, had a greater overall burden of comorbidities, and were more likely to undergo nonsurgical therapy. The authors suggest that patients with oropharynx or oral cavity tumors are less likely to receive MDC and that consultation with a speech-language pathologist before treatment is rare. The authors also state that there were delays in time to initiate definitive treatment for patients receiving MDC, but there were no delays in time to initiate adjuvant therapy for surgical patients. Last, they were unable to find a difference in oncologic outcomes between those with or without MDC.

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