Department of Otolaryngology, Washington University in St Louis, St Louis, Missouri.
JAMA Otolaryngol Head Neck Surg. 2017 Dec 1;143(12):1213-1219. doi: 10.1001/jamaoto.2017.1855.
Contemporary management of head and neck cancer involves professionals from multiple specializations. Streamlined care that reduces delays yet allows for comprehensive evaluation is needed.
To evaluate a single-day, single-appointment, multidisciplinary head and neck clinic model for reduction in treatment delay and comprehensiveness of care.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort analysis was conducted from June 1, 2015, to July 31, 2016, of outpatients at a single, academic medical center. All eligible outpatients seen in either the multiple-appointment, traditional clinic (n = 73) or the single-day multidisciplinary clinic (MDC) (n = 68) were included. Patients with new squamous cell carcinoma of the oropharynx, hypopharynx, sinonasal tract, and larynx, along with any mucosal site recurrence were eligible for the study.
Primary outcomes were delays between tertiary clinic referral or first appointment and treatment initiation in the MDC compared with the traditional clinic. Secondary outcomes were complete evaluations prior to treatment, enrollment in trials and registries, and rate of patient leak, defined as initiating therapy and then transferring to another center before completion. Outcome selection and hypothesis generation were performed a priori.
Patient factors and tumor characteristics were similar between the traditional clinic cohort (19 women and 54 men; mean [SD] age, 64.0 [10.2] years) and the MDC cohort (8 women and 60 men; mean [SD] age, 61.0 [8.9] years). The MDC cohort had significantly fewer instances of delay greater than 30 days from referral to treatment initiation (28 [41%] vs 43 [59%]) and first appointment to treatment initiation (7 [10%] vs 17 [23%]). Actual median days in these categories were significantly different between the 2 clinic types after the patients in the traditional clinic who saw only a surgeon before treatment initiation were excluded (MDC, 28 days vs traditional, 35 days; median difference, –5 days; 95% CI, –11 to –1).
Coordination of the management of head and neck cancer is complex. Treatment is time sensitive, and frequently clinician resources are limited. This MDC model was associated with improved efficiency and completeness of care.
头颈部癌症的当代治疗涉及多个专业的专业人员。需要简化护理，减少延迟，但又允许进行全面评估。
评估单天，单次预约，多学科头颈部诊所模式，以减少治疗延迟和护理的全面性。
设计，地点和参与者：对 2015 年 6 月 1 日至 2016 年 7 月 31 日在一家学术医疗中心的门诊患者进行了回顾性队列分析。所有符合条件的在多就诊，传统诊所（n = 73）或单天多学科诊所（MDC）（n = 68）就诊的门诊患者均包括在内。患有口咽，下咽，鼻窦和喉的新的鳞状细胞癌以及任何粘膜部位复发的患者有资格进行这项研究。
主要结果是与传统诊所相比，MDC 中从三级诊所转诊或首次就诊到开始治疗之间的延迟。次要结果是在开始治疗之前进行完整的评估，参加试验和注册以及患者漏诊的发生率，定义为开始治疗后转至另一家中心完成治疗。选择和生成假设是在事先进行的。
传统诊所队列（19 名女性和 54 名男性；平均[标准差]年龄，64.0 [10.2]岁）和 MDC 队列（8 名女性和 60 名男性；平均[标准差]年龄，61.0 [8.9]岁）的患者因素和肿瘤特征相似。MDC 队列中从转诊到开始治疗的时间延迟超过 30 天的情况明显少于传统诊所队列（28 [41％]与 43 [59％]），并且从首次就诊到开始治疗的时间延迟也明显少于传统诊所队列（7 [10％]与 17 [23％]）。在排除了传统诊所中仅在治疗前见到外科医生的患者后，这两种类型的诊所之间的实际中位数天数有明显差异（MDC，28 天；传统，35 天；中位数差，-5 天；95％CI，-11 至-1）。
头颈部癌症的管理协调非常复杂。治疗时间紧迫，并且经常受到临床医生资源的限制。这种 MDC 模型与提高效率和护理的完整性有关。
