Is Multidisciplinary Team Care for Head and Neck Cancer Worth It?

by Karam W. Badran, MD, Thomas E. Heineman, MD, Edward C. Kuan, MD, MBA, and Maie A. St. John, MD, PhD •

TRIO Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.

Background

The delivery of head and neck (H&N) cancer care continually is expanding. The rapid growth of complex multimodal treatment options and the emergence of new areas of cancer care intervention have allowed for potentially more efficacious therapeutic options. Given the complex functional and anatomic sites of H&N cancer, diagnosis, treatment, and long-term support require seamless, team-based, and specialist-driven continuity of care. Increasing specialization in the treatment of H&N cancer patients has led to the introduction of multidisciplinary teams (MDTs), the demand for which rapidly has increased in recent years.

Composed of physicians (H&N surgeons, medical and radiation oncologists) and nonphysician members (speech/occupational therapists, psychologists, and social workers), the MDT conference combines the perspective of a diverse group to improve the diagnostic and treatment plan for each patient. The benefits of group discussion, care coordination, and shared decision making are apparent, and they frequently are addressed in review and opinion publications. However, despite literature that has shown MDTs to improve cancer staging, and subsequently the patient outcomes, a large proportion of newly diagnosed H&N cancer patients still are managed without MDTs due to perceived costs and inefficiencies. Opinions expressed include the potential impact on cost and time, which may cause some clinicians to argue that MDTs are not practical for all patients. Therefore, we sought to investigate the literature for evidence detailing the impact of H&N cancer outcomes in relation to the costs associated with the implementation of MDT conferences.

Best Practice

Despite the lack of standardization among MDT groups at a variety of institutions, all reported literature supports a positive relationship between improved care coordination, adherence to clinical guidelines, reduced time to treatment, and improved survival following MDT discussion. This, taken in conjunction with the plethora of similar survival results among non-H&N (i.e., breast, lung, colorectal) cancers, has resulted in a new standard of care advocating for MDT for all H&N cancer patients. Further studies are required to better assess resource allocation, cost-effectiveness, and quality-of-life outcomes. Thus, all H&N cancer patients requiring single or multimodality therapy for advanced H&N cancer should be presented at MDT conference (Laryngoscope. 2018;128:1257–1258).