After the session, Miriam Lango, MD, an oncologist at the Fox Chase Cancer Center in Philadelphia, asked, “What do you do with the patient with a T4 larynx cancer who has a dysfunctional larynx but refuses total laryngectomy? All the surgeons may agree that the patient needs a total laryngectomy, but there’s no shortage of medical and radiation oncologists who would consent to trying primary chemoradiation.”
Explore this issue:June 2015
Panelist Carol Bradford, MD, professor and chair of otolaryngology at the University of Michigan Comprehensive Cancer Center in Ann Arbor, said the patient’s wishes and goals of care are very important. “I think our job as physicians is to present the various treatment modalities and our recommendation and help patients understand to the best of their ability.”
She suggested that the patient meet with a speech pathologist or those who have previously had laryngectomies. “You inform as best as you can, but at end of the day, the patient gets to choose,” she said.
Melanoma Tumor Boards
Dr. Bradford said a patient education focus is one element that has come out of the melanoma tumor boards at her center. “One of the things we do that’s really interesting is to teach our patients how to follow themselves,” she said. “They all get an instructional DVD that demonstrates self skin and lymph node exams. We do not recommend highly expensive surveillance testing, but we do recommend regular visits with a dermatologist and a primary care doctor twice a year for three years.”
Those visits involve a history and physical and a careful review of systems, with more tests ordered only when those screening tests are positive.
Her university also convenes a tumor board for Merkel cell carcinoma, a rare malignant tumor now known to be potentially related to a virus and one that results in worse outcomes for immunosuppressed patients. “We developed an algorithm of how we would treat these patients,” she said. The university also kept a registry of their results, which may later be published.
“I think that the role of the multidisciplinary tumor board is important,” Dr. Bradford said. “It really fostered part of my own scholarship and the scholarship of many others…. The collaboration is how we really improve care for our patients.”
Thomas Collins is a freelance medical journalist based in Florida.