The Impact of a Dedicated Multidisciplinary Care Team on a High-Risk Head and Neck Cancer Population

Abstract

While the Multidisciplinary Tumor Board (MTB) is the accepted best practice for the management for head and neck cancer, there is a paucity of evidence demonstrating its impact on treatment outcomes. Our goal was to investigate the impact of MTB following the hiring of a fellowship trained head and neck surgeon and implementation of an expanded MTB. As minorities and underinsured patients have consistently had worse outcomes and survival in HNSCC, we hypothesized that these changes would improve survival in our high-risk cohort. A review of head and neck squamous cell carcinomas (HNSCC) treated at our institution between 10/2006 and 5/2015 was performed. The cohort was divided into historical (10/06-2/11) and contemporary (2/11-5/25) cohorts. Prior to 2/2011, the MTB at that time did not consistently include a dedicated surgeon or additional members. In 2/2011 a dedicated fellowship trained head and neck surgeon joined the MTB, and the MTB was expanded with additional members including: speech/swallow therapy, social work, neuroradiology, pathology, and dental. Patients without a HNSCC primary, who were not managed by an otolaryngologist within the institution, had inadequate records, or did not receive any treatment, were excluded. A total of 224 patients were included, with 98 patients in the historical cohort and 126 in the contemporary cohort. 139 (62%) of the patient cohort were black and 91 (40%) were Medicaid or uninsured. Average follow-up time was 2.87 years. Of the overall cohort, 25% were stage I/II and 68% were stage III/IV. OS and DSS in the contemporary cohort were statistically significantly improved over the historical cohort on univariate analysis, and also on multivariate analysis when controlling for age, sex, race, and tobacco use. On Kaplan-Meier evaluation, OS and DSS were significantly different with 5-year DSS of 52% versus 75% (P = .003), respectively. This OS and DSS difference persisted when evaluating only stage III/IV cancers (P = .02). When excluding oropharynx cancers to eliminate potential imbalance from HPV-associated oropharynx cancers, DSS remained statistically significant (P = .02). Average time to treatment was not significantly different. Surgery was more commonly employed for advanced HNSCC treatment in the contemporary group (P = .0067) Implementation of an expanded MTB and dedicated head and neck surgeon had significant impact on OS and DSS for advanced HNSCC. Our study corroborates the belief that treatment of HNSCC by a dedicated multidisciplinary team results in best outcomes for patients. Implementing expanded MTB and specialty surgeon support should be considered to help address HNSCC racial disparity outcomes.