Academic Head and Neck Surgery: Educating Our Future

Multidisciplinary care has become the standard of care for most squamous cancers of the head and neck and the place of surgery in that care continues to evolve. While chemoradiotherapy has become the standard central treatment for most pharyngeal and laryngeal cancers, surgery remains the central treatment of oral cavity cancers. In parallel to the rise of non-surgical therapies, there has been more of an understanding and attempt to maximize both quality of life and functional outcomes. So, although targeted and neoadjuvant therapy may reduce the need for surgery, it is likely that in selected cases, surgery—in particular, less invasive approaches—may also have an important role in maximizing functional outcomes.

‘Tobacco and alcohol use will never be eliminated; in fact, the absolute number of smokers has remained relatively constant over the last 40 years at approximately 50 million.’

The head and neck surgeon is best positioned to understand the complex choices available to the head and neck cancer patient, and as such, it is he or she who must lead the multidisciplinary team. It is imperative for the head and neck surgeon to play a leading role in shaping the future of head and neck oncologic care as we will remain central to the evaluation of, treatment selection for, and salvage of squamous carcinoma of the head and neck.

Reducing the Burden of Disease

3) It is our obligation to attempt to shape the future for the better.

How can we shape the future, not simply to protect the field of otolaryngology or the surgeon’s pocketbook? While these are important, the pursuit of a future in the context of public health and multidisciplinary foundations is more likely to be viewed as legitimate by the broader health-care community as well as policy-makers and consequently more likely to actually effect change. To this end, our guiding principles should be to reduce the disease burden on society and to enhance the cost-effectiveness of care, and in shaping the future paradigm of head and neck surgical training we should work from these principles.

Simply put, to reduce the disease burden (i.e., reduce incidence and mortality as well as better manage prevalent cases) we must educate future clinicians to improve prevention, detection, treatment, and rehabilitation. Of course, as principally clinicians we focus on treatment, and better treatment of cancer should be more cost-effective.

Refining Multidisciplinary Education

To improve current and future treatment, multidisciplinary education is necessary. While many current head and neck fellowships have provided outstanding surgical training, the mentoring needed to integrate surgery into and to oversee the complex multimodal therapeutic puzzle is lacking. While the potentials of radiation, chemotherapy, and targeted therapy are required learning, future head and neck surgical trainees must develop openness to these potentials so that they can manage multidisciplinary care and honestly integrate surgery into this paradigm.