Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. In the absence of high-level evidence base for follow-up practices, the duration and frequency are often at the discretion of local centres. By reviewing the existing literature and collating experience from varying practices across the UK, this paper provides recommendations on the work up and management of lateral skull base cancer based on the existing evidence base for this rare condition. Recommendations • Patients should be followed up to a minimum of five years with a prolonged follow-up for selected patients. (G) • Patients should be followed up at least two monthly in the first two years and three to six monthly in the subsequent years. (G) • Patients should be seen in dedicated multidisciplinary head and neck oncology clinics. (G) • Patients should be followed up by dedicated multidisciplinary clinical teams. (G) • The multidisciplinary follow-up team should include clinical nurse specialists, speech and language therapists, dietitians and other allied health professionals in the role of key workers. (G) • Clinical assessment should include adequate clinical examination including fibre-optic rigid or flexible nasopharyngolaryngoscopy. (R) • Magnetic resonance imaging and positron emission tomography combined with computed tomography imaging should be used when recurrence is suspected. (R) • Narrow band imaging can be used in the follow-up in selected sites. (R) • Second primary tumours should be part of rationale of follow-up and therefore adequate screening strategies should be used to detect them. (G) • Patients should be educated with regard to the appearance and detection of recurrences. (G) • Patients with persistent pain should be investigated to exclude recurrent disease. (R) • Patients should be offered support with tobacco and alcohol cessation services. (R).
Highlights
It is accepted that the follow-up of patients who had treatment for head and neck cancers is a fundamental part of their care.1–4 The reasons of post-treatment follow-up include: Evaluation of treatment response Early identification of recurrence Early detection of new primary tumours Monitoring and management of complications Optimisation of rehabilitation Provision of support to patients and their families.Controversy exists in how these aims are achieved.5,6 Increasing efforts are being made to rationalise the structure and timing of head and neck follow-up clinics.Downloaded from https://www.cambridge.org/core
Patients should be seen in dedicated multidisciplinary head and neck oncology clinics. (G)
Magnetic resonance imaging and positron emission tomography combined with computed tomography imaging should be used when recurrence is suspected. (R)
Summary
It is accepted that the follow-up of patients who had treatment for head and neck cancers is a fundamental part of their care. The reasons of post-treatment follow-up include:. It is accepted that the follow-up of patients who had treatment for head and neck cancers is a fundamental part of their care.. Increasing efforts are being made to rationalise the structure and timing of head and neck follow-up clinics. Evidence to support follow-up for early detection of tumour recurrence is lacking. In order to rationalise follow-up, patients could be divided into low and high risk. This is well recognised in thyroid cancer, but it is not the case in all other types of head and neck cancer especially squamous cell carcinoma (SCC). Setting At present, 90 per cent of the clinicians treating head and neck cancer in the UK see the patients in dedicated head and neck clinics for the duration of the follow-up. Patients should be seen in dedicated multidisciplinary head and neck oncology clinics (G)
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