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27 Jul 2019

Improving head and neck cancer outcomes: the critical role of primary care

  • Victorian Comprehensive Cancer Centre

Primary care practitioners are the frontline of cancer identification. From dentists and general practitioners, to physiotherapists, occupational therapists and other allied health fields these professionals play a key role in reducing cancer incidence.

Victorian Comprehensive Cancer Centre (VCCC) Research & Education Lead, Associate Professor David Wiesenfeld explores the essential connection between primary care and oncology in relation to the notoriously difficult to detect head and neck squamous cell carcinoma or head and neck cancers.

Changing causes and future predictions

It is clear from studies that early diagnosis of head and neck cancers lead to a better prognosis and contributes to reduced treatment morbidity.

Early diagnosis depends upon two approaches:

  1. Community awareness of symptoms leading patients to seek care
  2. Primary capability with diagnostic testing expertise

Cancer Council Victoria’s publication of 2017 statistics and trends placed head and neck cancers tenth in incidence overall and sixth for males.

Community education and government policies have contributed to a change in the cause of head and neck cancers. Years of cumulative tobacco and alcohol use is now a well recognised prime cause for adding risk to head and neck cancer development. Nonetheless several years of social change is required to translate to a reduction in cancers caused by smoking.

In addition, there is an increasing number of non-smoking, non-drinking females who have developed oral squamous cell carcinoma, a type of head and neck cancer. Further epidemiological studies are required to understand the changes in this special patient group.

Oropharyngeal cancer is another type of head and neck cancer related to the Human Papilloma Virus (HPV); incidences are also rising. In Australia, the HPV vaccine program has been available to females aged 14 and under, since 2007, and males in the same age group, since 2013. The vaccine has been proven to reduce rates of HPV-related cervical cancer and is expected to result in a reduction in HPV-related oropharyngeal cancer over the next 20 years.

Survival rate of head and neck cancers is currently less than 70 per cent; modelling predicts a 50 per cent incidence increase by 2032, leading to increasing service provision challenges. These figures do not include expected increases in head and neck cutaneous cancer or thyroid cancer, which alone is predicted to rise to over 1,200 per year in the same period.

Clinical care, education and ongoing research

Taking advantage of the the VCCC alliance members; seven hospitals, two medical research institutes and the University of Melbourne, we connect and establish improved clinical care through evidence-based, research outcomes.

Innovations, conducted by the VCCC alliance members, in immunotherapy, radiation and surgery are contributing to overall survival rates and improved quality of life for patients.

An educational program developed by the VCCC, is providing primary care practitioners with the fundamentals of head and neck cancer detection, care and survival.

Head and neck cancers include several sites and tumour types:

  • Mouth
  • Pharynx (throat)
  • Larynx (voice box)
  • Nasal cavity
  • Skull base
  • Cutaneous (skin)
  • Salivary glands
  • Thyroid gland
  • Sarcoma (connective tissue)

Best outcomes for patients result from a multi-disciplinary team approach with adequate clinical and research resources, encompassing medical specialists, oncologists, palliative care, allied health, speech pathologists, dieticians, physiotherapists, psychologists, occupational therapists, prosthetists, social workers, nurses and dentists.

The team has a role in treatment planning and provision, as well as professional and community education and research.

World Head and Neck Cancer Day, 27 July

World Head and Neck Cancer Day was declared by the International Federation of Head and Neck Oncologic Societies on 27 July 2014. The day raises awareness and draws the world’s attention to effective care and control of head and neck squamous cell carcinoma.

Patients with head and neck cancers, their families, carers and treating practitioners contribute to and participate in the day, celebrating current patients, survivors and those in memoriam.

This World Head and Neck Cancer Day, please take this opportunity to reflect on the care of patients, meeting their needs and providing appropriate supportive care for them and their families. Acknowledging the needs of patients, and the strengths and deficiencies in current management, is the first step to improving outcome and quality of life.