2 Background: Head and neck cancer is associated with significant morbidity and mortality, yet little is known about the frequency and content of discussions addressing patients’ values, goals of care, and treatment preferences. Methods: Using an institutional cancer registry, we conducted a retrospective analysis of 70 decedents who underwent surgical treatment for squamous cell carcinoma of the head and neck. We abstracted patients’ medical records using a standardized template. An independent reviewer re-abstracted 20% of the records. For abstracted data pertaining to documented values, goals of care, and/or treatment preferences our inter-rater reliability was greater than 93%. Results: The mean age at diagnosis was 66 years and 69% were male. An enduring advance directive, a completed Physician Order for Life Sustaining Treatment form, and a serious illness conversation documented in the medical record were noted in 27%, 4%, and 49% of the medical records, respectively. Half of the documented goals of care discussions were held in the inpatient setting, over 50% were held in the last month of life, and 25% were held in the last week of life. These conversations involved specialist palliative care providers (47%), hematologist/oncologists (41%), hospitalists (32%), head and neck surgeons (21%), radiation oncologists (19%), and intensivists (18%). None of these discussions involved patients’ primary care providers. Of those with a known location of death, 58% died in the hospital and 4 out of 5 of these patients died during attempted cardiopulmonary resuscitation. Conclusions: In this retrospective analysis, serious illness communication was documented in the minority of patients who died of head and neck cancer. These discussions occurred late in the trajectory of illness. The continuity relationships of teams treating head and neck cancer patients (e.g., head and neck surgeon, radiation/oncologist and hematologist/oncologist) situate these clinicians in the best position to enact serious illness conversations. These data suggest that opportunities to have these discussions upstream are often missed.
Survival of dental implants in native and grafted bone in irradiated head and neck cancer patients: A retrospective analysis
