Quality statement 4: Choice of treatment

Quality statement

People with cancer of the upper aerodigestive tract are given the choice of either radiotherapy or surgery if both are suitable options for their type of cancer.

Rationale

People with cancers of the upper aerodigestive tract that have similar outcomes from radiotherapy and surgery should be told that both of these treatments are available and what they involve. This should include details of the potential side effects (including late effects). Clear explanation and support from healthcare professionals should help people with cancers of the upper aerodigestive tract to make a fully informed choice of treatment based on their preference and should increase patient satisfaction.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that people with cancer of the upper aerodigestive tract are given a choice of either radiotherapy or surgery if both are suitable options for their type of cancer.

Data source: Local data collection, National Peer Review: Head and neck cancer services, National Peer Review Programme and HANA (Head and Neck Cancer National Audit), Saving Faces.

Process

a) Proportion of people with newly diagnosed T1b–T2 squamous cell carcinoma of the glottic larynx who are given a choice of surgery or radiotherapy.

Numerator – the number in the denominator who are given a choice of surgery or radiotherapy.

Denominator – the number of people with newly diagnosed T1b–T2 squamous cell carcinoma of the glottic larynx.

Data source: Local data collection, National Peer Review: Head and neck cancer services, National Peer Review Programme and HANA (Head and Neck Cancer National Audit), Saving Faces.

b) Proportion of people with newly diagnosed T1–T2 squamous cell carcinoma of the supraglottic larynx who are given a choice of surgery or radiotherapy.

Numerator – the number in the denominator who are given a choice of surgery or radiotherapy.

Denominator – the number of people with newly diagnosed T1–T2 squamous cell carcinoma of the supraglottic larynx.

Data source: Local data collection, National Peer Review: Head and neck cancer services, National Peer Review Programme and HANA (Head and Neck Cancer National Audit), Saving Faces.

c) Proportion of people with T1–2 N0 tumours of the oropharynx who are given a choice of surgery or radiotherapy.

Numerator – the number in the denominator who are given a choice of surgery or radiotherapy.

Denominator – the number of people with T1–2 N0 tumours of the oropharynx.

Data source: Local data collection, National Peer Review: Head and neck cancer services, National Peer Review Programme and HANA (Head and Neck Cancer National Audit), Saving Faces.

d) Proportion of people with T3 squamous cell carcinoma of the larynx who are given a choice of either radiotherapy with concomitant chemotherapy or surgery with adjuvant radiotherapy, with or without concomitant chemotherapy.

Numerator – the number in the denominator who are given a choice of either radiotherapy with concomitant chemotherapy or surgery with adjuvant radiotherapy, with or without concomitant chemotherapy.

Denominator – the number of people with T3 squamous cell carcinoma of the larynx.

Data source: Local data collection, National Peer Review: Head and neck cancer services, National Peer Review Programme and HANA (Head and Neck Cancer National Audit), Saving Faces.

Outcome

Satisfaction with treatment for people with cancers of the upper aerodigestive tract that have similar outcomes from radiotherapy and surgery.

Data source: Local data collection and the National Cancer Patient Experience Survey, Quality Health.

What the quality statement means for different audiences

Service providers (head and neck cancer secondary and tertiary care services) ensure that people with cancer of the upper aerodigestive tract are told about both radiotherapy and surgery if they are both suitable options for their type of cancer. Discussion should include the potential side effects, and people should be given a choice based on their preference. If the service does not provide both treatment options, it should refer people to a local centre which provides the treatment they wish to have.

Healthcare professionals (members of head and neck cancer multidisciplinary teams) clearly explain radiotherapy and surgery to people with cancer of the upper aerodigestive tract if they are both suitable options for their type of cancer. This discussion should include the potential side effects, so that people can decide which they would prefer.

Commissioners (NHS England) ensure that they commission services which clearly explain radiotherapy and surgery to people with cancer of the upper aerodigestive tract if both are suitable options for the type of cancer. Discussion should include the potential side effects, and people should be given a choice based on their preference. Commissioners should ensure that the services commissioned either offer both radiotherapy and surgery or refer people to a local centre which provides the treatment a person wishes to have.

People with some cancers of the vocal cords are told what the different treatment options involve, including any side effects. This will help them to choose which treatment is best for them. If they choose a treatment that is not available at their local service, they should be referred to another local centre that can provide the treatment.

Source guidance

Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over (2016) NICE guideline NG36, recommendations 1.3.2, 1.3.3, 1.3.6 and 1.4.1

Definitions of terms used in this quality statement

Cancer of the upper aerodigestive tract for which radiotherapy or surgery are suitable options

These are:

  • newly diagnosed T1b–T2 squamous cell carcinoma of the glottic larynx

  • newly diagnosed T1–T2 squamous cell carcinoma of the supraglottic larynx

  • T1–2 N0 tumours of the oropharynx

  • T3 squamous cell carcinoma of the larynx.

[Adapted from NICE's guideline on cancer of the upper aerodigestive tract, recommendations 1.3.2, 1.3.3, 1.3.6 and 1.4.1]