Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
JAMA Otolaryngol Head Neck Surg. 2020 Dec 1;146(12):1136-1146. doi: 10.1001/jamaoto.2020.3496.
Multidisciplinary care (MDC) yields proven benefits for patients with cancer, although it may be underused in the complex management of head and neck squamous cell carcinoma (HNSCC).
To characterize the patterns of MDC in the treatment of HNSCC among elderly patients in the US.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide, population-based, retrospective cohort study used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data from January 1, 1991, to December 31, 2011, to identify patients 66 years or older diagnosed with head and neck cancer and determine the dates of diagnosis, oncology consultations, treatment initiation, and speech therapy evaluation in addition to MDC completion. Multidisciplinary care was defined in a stage-dependent manner: localized disease necessitated consultations with radiation and surgical oncologists, and advanced-stage disease also included a medical oncology consultation, all before definitive treatment. Data were analyzed between December 2016 and September 2020.
Rates of MDC across all subsites of head and neck cancer as measured by the presence of an evaluation for each oncologist on the MDC team and its effect on treatment initiation.
This cohort study assessed 28 293 patients with HNSCC (mean [SD] age, 75.1 [6.6] years; 67% male; 87% White) from the SEER-Medicare linked database. The HNSCC subsites included larynx (40%), oral cavity (30%), oropharynx (21%), hypopharynx (7%), and nasopharynx (2%). Overall, the practice of MDC significantly increased over time, from 24% in 1991 to 52% in 2011 (P < .001). For patients with localized (stage 0-II) tumors, 60% received care in the multidisciplinary setting, whereas 28% of those with advanced-stage disease did. A total of 18 181 patients (64%) were treated with initial definitive nonsurgical therapy across all stages. Regardless of stage and subsite, few patients (2%) underwent evaluation by a speech-language pathologist before definitive therapy. Multidisciplinary care prolonged the time to initiation of definitive treatment by 11 days for localized disease and 10 days for advanced disease.
This cohort study found that most elderly patients with localized HNSCC received MDC, whereas few patients with advanced-stage disease received such care, although a significant proportion received adjuvant therapy. Multidisciplinary care may prolong time to initiation of definitive treatment with an uncertain impact. Consultation with a speech-language pathologist before definitive therapy was rare.
多学科治疗（MDC）为癌症患者带来了已证实的益处，尽管在头颈部鳞状细胞癌（HNSCC）的复杂治疗中可能未得到充分利用。
描述美国老年患者 HNSCC 治疗中 MDC 的模式。
设计、设置和参与者：本项全国性、基于人群的回顾性队列研究使用 1991 年 1 月 1 日至 2011 年 12 月 31 日期间的监测、流行病学和最终结果（SEER）-医疗保险链接数据，识别出 66 岁或以上诊断患有头颈部癌症的患者，并确定诊断、肿瘤学咨询、治疗开始以及言语治疗评估的日期，此外还确定了 MDC 完成的日期。MDC 以依赖于分期的方式定义：局部疾病需要与放射肿瘤学家和外科肿瘤学家进行咨询，而晚期疾病还包括医学肿瘤学咨询，所有这些都是在明确治疗之前进行的。数据分析于 2016 年 12 月至 2020 年 9 月之间进行。
通过 MDC 团队中每位肿瘤学家的评估以及其对治疗开始的影响，评估所有头颈部癌症亚部位的 MDC 率。
本队列研究评估了来自 SEER-医疗保险链接数据库的 28293 名 HNSCC 患者（平均[标准差]年龄，75.1[6.6]岁；67%为男性；87%为白人）。HNSCC 亚部位包括喉（40%）、口腔（30%）、口咽（21%）、下咽（7%）和鼻咽（2%）。总体而言，MDC 的实践随着时间的推移显著增加，从 1991 年的 24%增加到 2011 年的 52%（P < .001）。对于局部（0 期-II 期）肿瘤患者，60%在多学科环境中接受治疗，而晚期疾病患者中只有 28%接受治疗。所有阶段的患者中，共有 18181 名（64%）接受了初始确定性非手术治疗。无论分期和亚部位如何，很少有患者（2%）在接受确定性治疗前接受言语语言病理学家的评估。多学科治疗使局部疾病患者开始确定性治疗的时间延长了 11 天，使晚期疾病患者的治疗时间延长了 10 天。
本队列研究发现，大多数患有局部 HNSCC 的老年患者接受了 MDC，而很少有晚期疾病患者接受此类治疗，尽管很大一部分患者接受了辅助治疗。多学科治疗可能会延长确定性治疗的开始时间，但影响不确定。在接受确定性治疗之前，很少有患者咨询言语语言病理学家。
