Impact of network organization on head and neck cancer control.

Prior to the Northern California Head and Neck Cancer Network, there had been no organized community effort regarding detection, management, and rehabilitation of head and neck cancers. Organization depended upon endorsement by the newly formed Northern California Cancer Program (NCCP) and membership of major treatment centers. Important developmental steps included financial support, a principal investigator, a representative multidisciplinary Steering Committee and By-laws. The organization established a support staff and subcommittees of volunteer professionals for the following areas: standards of care (state-of-the-art); patient management guidelines; epidemiology and evaluation; pre-treatment conferences; screening programs and dental hygienist training; demonstration of rehabilitation techniques; and professional education. Assessment of the contract period with a baseline year indicated beneficial and progressive standards of care, improved referral patterns, and areas of weakness useful in guiding future educational efforts. Utilizing a large target population of almost 9 million and 72 institutions responsible for more than 80% of the cancer patients yielded data on 1,790 patients that was meaningful and realistic regarding cancer control. The pre-treatment conferences in four different geographic locations are continuing, as well as rehabilitation programs in each area. The cooperative multidisciplinary, multi-institutional efforts developed during the contract are continuing in educational and research programs. Screening programs were shown not to be cost effective.