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Improving Head and Neck Cancer Outcomes

Joe Cantlupe, for HealthLeaders Media, January 8, 2011
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Head and neck cancer afflicts relatively few, but it is described as one of the most devastating because of its impact on speech, swallowing, and facial structures.

By establishing multidisciplinary approaches and minimally invasive techniques, hospitals are improving patient outcomes and their own bottom lines.

Despite anticipated declines in head and neck cancers linked to tobacco smoking, the healthcare industry expects increasing tumors in oral cancers related to sexually transmitted diseases, prompting service line leaders to expect an added growth of patient load.

Hospitals that have developed multidisciplinary programs are seeing more revenue for such programs, despite the relatively low volume—just 3% to 5% of cancers nationwide.

“Any hospital offering treatment for cancer must have a comprehensive, multidisciplinary head and neck cancer program,” says William M. Keane, MD, chairman of the department of otolaryngology at the 616-bed Thomas Jefferson University Hospital in Philadelphia. “Such a team would include head and neck surgeons, radiation oncologists, medical oncologists, radiologists, and pathologists, as well as a support staff to include rehabilitation and social services,” Keane says. “Such an approach offers minimally invasive, organ-sparing treatment because it allows for improved cure rates while preserving form and function, such as speech and swallowing and external appearance.”

More than 50,000 Americans are diagnosed with cancers of the head and neck each year, and throat cancer occurs in the mouth and throat, including the tonsils, tongue base, and voice box. About 80% of all head and neck cancers are caused by tobacco and alcohol use.

The University of Chicago Medical Center, which is among the healthcare facilities focusing on multidisciplinary techniques, concentrates on innovative chemotherapy and radiation treatments that have resulted in improved outcomes, such as improved survival rates with patients of head and neck cancer, says Kerstin Stenson, MD, FACS, director of the 532-staffed-bed medical center’s head and neck cancer program.

Mount Sinai Medical Center in New York, a 1,171-bed facility, has experienced a threefold increase in patient care through its multidisciplinary approach within the past decade, according to Eric Genden, MD, chairman of the department of otolaryngology and director of the head and neck cancer center.
With those improving outcomes and the possibility of widespread therapy, the word spreads that this is the place to go, Genden says.

Another key technique is the growing use of the da Vinci robot, which allows for reduced structural damage and improved patient outcomes, Genden says. The procedure was approved for head and neck care in 2009 by the Food and Drug Administration.

“It is the paradigm shift in our treatment, with minimally invasive robotic surgery that leaves patients with improved ability to swallow and speak and function,” says Tod C. Huntley, MD, FACS, partner in the Center for Ear, Nose, Throat, and Allergy PC, a private practice that works out of 841-staffed-bed St. Vincent’s Health System in Indianapolis. He also is codirector of head and neck cancer services at St. Vincent’s.

An especially difficult aspect of treating head and neck cancer is the effects of treatment. “It is not one of the most high-profile of cancers, but it is one of the most devastating, out of proportion to its prevalence,” says Bert W. O’Malley Jr., MD, chairman of the department of otolaryngology and head and neck surgery for the 1,554-bed University of Pennsylvania Health System based in Philadelphia.

Infection with certain strains of the human papillomavirus can increase the risk of oropharyngeal cancers.

“We know the national trends for this disease are going up,” says Randal S. Weber, MD, FACS, chairman of the department of head and neck surgery at the 571-bed University of Texas MD Anderson Cancer Center. “We are utilizing a controlled approach and it will have to compare the cost of care, robotics or chemotherapy, and surgery.”

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