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Improving outcomes in head and neck cancers [CSG6]

Measuring the use of this guidance

Recommendation: Pre-treatment

Careful assessment of each patient’s clinical, nutritional and psychological state is crucial to inform treatment planning. Multidisciplinary teams (MDTs) should therefore establish multi-disciplinary pre-admission clinics at which all aspects of the case can be considered by appropriate specialists, and members of the MDT can discuss the way forward with individual patients and their carers.

What was measured: Proportion of people who had their care discussed at a multi-disciplinary team meeting.
Data collection end: October 2014
97.5%
Area covered: England and Wales
Source: Health and Social Care Information Centre. National Head and Neck Cancer Audit.


Recommendation: Pre-treatment 2

A clinical nurse specialist (CNS) should ensure that all patients and carers receive appropriate support and information, that their nonmedical needs are assessed, and that there is effective liaison between hospital.

What was measured: Proportion of people seen pre-treatment by a Clinical Nurse Specialist (CNS).
Data collection end: October 2014
61.8%
Area covered: England and Wales
Source: Health and Social Care Information Centre. National Head and Neck Cancer Audit.


Recommendation: Pre-treatment 3

The patient’s presenting symptoms should be assessed. Members of the MDT – in particular, the palliative care specialist and the speech and language therapist (SLT) - should become involved in the immediate management of those whose symptoms are difficult to control. Co-morbidity, performance status, psychological state, and alcohol dependence should also be assessed early, using validated techniques. The nutritional status of the patient should be assessed by a dietician who can initiate immediate action to remedy any deficiencies.

What was measured: Proportion of people who have a pre-treatment speech and language therapy assessment.
Data collection end: October 2014
27.4%
Area covered: England and Wales
Source: Health and Social Care Information Centre. National Head and Neck Cancer Audit.

What was measured: Proportion of people who have a pre-treatment nutritional assessment.
Data collection end: October 2014
31.7%
Area covered: England and Wales
Source: Health and Social Care Information Centre. National Head and Neck Cancer Audit.


Recommendation: Pre-treatment 4

All patients with upper aero-digestive tract (UAT) cancers should have chest X-rays. Other forms of imaging are necessary to assess the stage and spread of the tumour, and specialist ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) should be available. If imaging shows possible tumour invasion of the skull, the patient should be referred to an MDT which has specific expertise in treating this type of problem. Positron emission tomography (PET) imaging should be used, if available, when it is important to differentiate between benign and malignant lung nodules. It is anticipated that the role of PET will increase over the course of the next decade.

What was measured: Proportion of people who have a pre-treatment chest CT/chest X-ray.
Data collection end: October 2014
71.5%
Area covered: England and Wales
Source: Health and Social Care Information Centre. National Head and Neck Cancer Audit.


Recommendation: Pre-treatment 5

Patients whose treatment will affect the mouth or jaw should be examined by a specialist dentist and any dental problems should be identified and treated before cancer treatment begins. Those who require dental extractions under general anaesthesia should see an oral surgeon. Patients who are to have radiotherapy should be treated without delay, to allow time for healing. A dental hygienist should work with these patients to achieve high standards of oral hygiene, to reduce problems after treatment. Patients’ dental prostheses should be assessed, along with the denture-bearing ridges, to check that the prosthesis is both comfortable and effective. Those who are to undergo surgery to the jawbone should be assessed by the restorative dentist who works with the surgeon in the MDT.

What was measured: Proportion of people who have a pre-treatment dental assessment.
Data collection end: October 2014
35.4%
Area covered: England and Wales
Source: Health and Social Care Information Centre. National Head and Neck Cancer Audit.



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