There are plenty of sources of information describing best practice in the treatment of head and neck patients. They range from the 2015 document  “Achieving World Class Outcomes”, many NICE guidelines and quality statements and the 2012 NHS document “Nothing About Me Without Me” .

A recent article in the Nursing Times describes the head and neck pathway at UHNM, in Stoke.

ARTICLE

There are many impressive features of the care they provide and I especially like a couple.

The team provide their patients with peer support, stratified into 3 streams head and neck, laryngectomee and thyroid.

Secondly there is an emphasis on patients being involved in decision-making about their care. Choice between alternative treatment options is highlighted in NICE guidelines and the patient view should figure highly in any such  discussions.

I don’t think there would be much argument about the title of this post. It seems to be common sense.

Many factors contribute to a delay, beyond the 62 day wait between urgent referral and start of treatment. The increase in demand for treatment and the shortage of key staff are particularly important here. Along the patient pathway a shortage of radiology and imaging staff is but one potential source of delay.

A recent study has highlighted the importance of meeting the target, with worse outcomes when this does not happen.

study

I am sure patient groups will want to stress at every opportunity that meeting the cancer target times has to be of the highest priority.

A recent post on the website of the Mayo Clinic (USA) talks about the need for patients to have a laryngectomy in future years.

Article

Being a bit pedantic, everything discussed still involves the removal of the voicebox but what may be avoided is the need for a neck stoma. Like many articles I read it portrays having a laryngectomy as a bleak outcome.

For some a laryngectomy, after a diagnosis of late-stage cancer, is a procedure that brings precious months or years survival. For others it enables them to return to a full life in most respects. There may be some problems with speech and swallowing but this is true for many head and neck cancer patients.

Two alternatives are presented but both have limitations. Larynx transplants are unlikely to be a viable solution , not least from the problem of finding sufficient donors and the handicap of needing immuno-supressive drugs for life.  Regenerative medicine, using stem cells has the advantages of needing no donor or drugs to combat rejection. However my understanding is that these techniques will need many more years before providing a practical solution.

One approach that is not mentioned is to develop an artificial robotic larynx, but like regenerative medicine many years more will be needed to develop a viable device.