Design Time trade‐off choice experiment. Setting Two large head and neck cancer centres. Participants Patients who have received treatment for head and neck cancer and members of the head and neck cancer multidisciplinary team. Main outcome measures Participants were asked to rank the outcome scenarios, assign utility values using time trade‐off and rate the importance of survival on treatment choice. Results A total of 49 patients with head and neck cancer and 73 staff members were recruited. Chemoradiotherapy ( CRT ) optimal outcome was the most preferred health state (34 of 49, 69% patients, and 50 of 73, 68% staff), and CRT with complications was least preferred (27 of 49, 55% patients, and 51 of 73, 70% staff). Using time trade‐off, mean utility values were calculated for CRT optimal outcome (0.73 for patients, 0.77 for staff), total laryngectomy ( TL ) optimal outcome (0.67 for patients, 0.69 for staff), TL outcome with complications (0.46 for patients, 0.51 for staff) and CRT with complications (0.36 for patients, 0.49 for staff). The average survival advantage required for a participant to change their preferred choice was 2.6 years. Conclusions We have demonstrated that a significant proportion of patients with head and neck cancer and staff members would not choose CRT to manage locally advanced laryngeal cancer. Staff members rated the health states associated with laryngeal cancer treatment higher than patients who have experienced them, and this is particularly evident when considering the poorer outcomes. The head and neck cancer community should develop methods of practice and decision‐making which incorporate elicitation and reporting of patient values as a central principle.
Abstract Background: Laryngeal dysplasia is an important pre-malignant lesion. In 2010, a consensus statement by ENT surgeons and pathologists was published outlining the management and follow up of patients with laryngeal dysplasia. Objective: After reviewing these guidelines, we noted the need for a flowchart for laryngologists to improve efficiency in managing dysplasia and encourage adherence to evidence-based protocols. Result: A diagram has been produced to aid other ENT units around the country.
The term comorbidity stands for disease processes that co-exist and are not related to the index disease being studied. Comorbidity in cancer has been shown to be a major determinant in treatment selection and survival. Patients with head and neck cancer can have significant comorbidity owing to the high incidence of tobacco and alcohol abuse. No studies to date have addressed this problem in head and neck cancer patients in the United Kingdom. The applicability of the adult comorbidity evaluation – 27 index (ACE-27) and the Charlson index (CI) to assess the comorbidity burden by retrospective notes review is studied here. Retrospective data collection and completion of a comorbidity index in a United Kingdom setting is feasible. We conclude that the pre-assessment visit is a useful time to record comorbidity and as a significant amount of information required for grading relates to historical items, this is best done using a self-administered patient questionnaire.
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Spontaneous temporal meningoencephaloceles are rare entities and diagnostic difficulties can occur. We present two cases whose presentation was atypical and diagnosis delayed by the presence of dual pathology.
Recurrent, unresectable head and neck squamous cancer is a complex problem. Evidence for the efficacy of treatment is scant in this area and given the large number of patient and tumor variables involved in the recurrent tumor, several factors play a role in deciding the choice of management. The results of treatment are very poor and associated with significant toxicity. Thus, the quality of life outcome following treatment should play a major role in the choice of treatment. Unfortunately, generation of quality-of-life data is hampered by several factors, not least of which are the ethical issues raised by end of life care. This article reviews the relevant literature, summarizes existing evidence and draws conclusions, identifies gaps in the knowledge and offers guidance for further research.
To provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO2 TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT].Expert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO2 TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process.The expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO2 TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up.Management of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO2 TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO2 TOLMS for LSCC in the salvage setting is presented.
Abstract Thyroid cancer is the most common endocrine malignancy and is increasing in frequency, representing 1% of all malignancies. Histological subtypes of thyroid cancer—papillary, follicular, medullary, and anaplastic behave differently and require different approaches to treatment. Multidisciplinary decision-making may lead to the offer of a range of treatments including hemithyroidectomy, total thyroidectomy, radioiodine remnant ablation, and neck dissection. Staging systems that permit evidence-based application of these therapeutic modalities are discussed.
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