How we care for patients with head and neck cancers is described in the first report from a new national data collection, published today. Findings from this ground breaking clinical audit paint a comprehensive picture of current treatment and provide a yardstick to help clinicians improve care for patients.
The audit is managed by The Health and Social Care Information centre, on behalf of the Healthcare Commission, and focuses on voice box (larynx) and mouth (oral cavity) cancers, which account for around 50% of all head and neck cancer registrations in England. The report covers the first 20 months of the audit, which collected data from 26 out of 34 English Cancer Networks.
Cancers of the mouth and throat are associated with heavy smoking and drinking and affect mainly older people (90% over age 50). Such cancers have a significant impact on functions such as eating, drinking, speech, swallowing and normal social interaction. Patients require intensive investigation, multiple treatments and prolonged rehabilitation with long-term support to achieve an adequate recovery.
Richard Wight, Consultant Head and Neck Surgeon, and Head and Neck Audit lead said: “The audit is still in its infancy but has already provided valuable information that will help clinicians provide patients with quality evidence-based care.
“Before we began we were of aware differing standards between different parts of England and even within the same region. We are now in a position to target the important gaps in provision, locally or nationally, press for resources and reorganisation to cope, and direct research to the real problem areas. In this way we aim to significantly improve the long-term survival rate in head and neck cancer without any advances in therapy.”
Next steps are to build on the information collected and to encourage NHS trusts and hospitals involved in care to improve their data recording. Some important aspects of caring for patients, such as dental assessment, speech and language therapy, dietetics and palliative care could not be assessed through the audit owing to an absence of data.
Key findings from the audit include:
- Care for one third of patients, is not recorded as discussed at a multi-disciplinary team meeting. As care for patients with throat and mouth cancer is complex and involves many specialists, these results may reflect inappropriate treatment decisions for some patients.
- There are delays in diagnostic imaging for a significant number of patients.
- There are early indications that voice box cancer is more common amongst people who live in deprived areas and more are diagnosed at an advanced stage.
- Around one in five of all referrals (21%) for cancer of the mouth are made by dentists and community dental services and demonstrates the importance of general dental services in screening for oral cavity cancer.
- Head and neck cancer patients may have difficulties in accessing radiotherapy services, which may produce delays to treatment. In future more comprehensive capture of radiotherapy data will help to clarify this.
- Overall, head and neck surgery despite being complex, appears, from the information submitted, to be a safe procedure with few peri-operative deaths recorded.
Prof Mike Richards, National Cancer Director comments: “The challenge now is to ensure that head and neck cancer teams in all cancer networks participate. I am convinced that comprehensive comparative audit will drive up the quality of care for patients, leading to better outcomes.”
Jonathan Boyce, Head of Audits at the Healthcare Commission said:
“This is an important audit which is starting to provide valuable information on how patients with cancer of the mouth or voice box are being treated, and how long they are waiting for treatment. But not all hospitals are contributing data yet and it is important that they do to help them identify and remedy problems with their own services. The aim is that 100% of trusts should contribute to the audit in order to promote improvement for patients with these cancers across the country.”
ENDS
Related links:
Download
DAHNO first annual report: Key findings from the National Head and Neck Cancer Audit (PDF, 2507K)
