BAHNO surgical specialities: same patients, different practices?

The British Association of Head and Neck Oncologists (BAHNO) is ’a multidisciplinary society for healthcare professionals involved in the study and treatment of head and neck cancer’. Surgical members of this organization are from three specialities (otolaryngology, maxillo-facial and plastic surgery). Although the overall impression is that the management of UK head and neck cancer patients is consensus based, there are appreciable differences in each surgical speciality’s practice. Anecdotally, this can lead to variation in the management of very similar patients. To identify some of these variations BAHNO surgeons were surveyed regarding their current head and neck cancer practices from the perspectives of surgical activity and post-operative care. Some unexpected differences were identified, particularly in relation to post-operative care with plastic and maxillo-facial surgeons demonstrating different patterns of high dependency unit (HDU) and intensive care unit (ICU) use for the same patients. The implications for future consensus in the light of these variations are discussed.

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Anaesthesia for head and neck surgery: United Kingdom National Multidisciplinary Guidelines

The Journal of Laryngology & Otology ◽

10.1017/s0022215116000384 ◽

2016 ◽

Vol 130 (S2) ◽

pp. S23-S27 ◽

Cited By ~ 10

Author(s):

P Charters ◽

I Ahmad ◽

A Patel ◽

S Russell

Keyword(s):

Intensive Care Unit ◽

Head And Neck Cancer ◽

Intensive Care ◽

Head And Neck ◽

Neck Cancer ◽

Neck Surgery ◽

World Health ◽

Operative Care ◽

Health Organization ◽

The Uk

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The anaesthetic considerations for head and neck cancer surgery are especially challenging given the high burden of concurrent comorbidity in this patient group and the need to share the airway with the surgical team. This paper provides recommendations on the anaesthetic considerations during surgery for head and neck cancer.Recommendations• All theatre staff should participate in the World Health Organization checklist process. (R)• Post-operative airway management should be guided by local protocols. (R)• Patients admitted to post-operative care units with tracheal tubes in place should be monitored with continuous capnography. Removal for tracheal tubes is the responsibility of the anaesthetist. (R)• Anaesthetists should formally hand over care to an appropriately trained practitioner in the post-operative or intensive care unit. (G)• Intensive care unit staff looking after post-operative tracheostomies must be clear about which patients are not suitable for bag-mask ventilation and/or oral intubation in the event of emergencies. (R)

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Outcomes for head and neck cancer patients admitted to intensive care in Australia and New Zealand between 2000 and 2016

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001602 ◽

2021 ◽

pp. 1-8

Author(s):

C A Frauenfelder ◽

E P Raith ◽

S Krishnan ◽

A Udy ◽

D Pilcher

Keyword(s):

Intensive Care Unit ◽

Head And Neck Cancer ◽

Intensive Care ◽

Hospital Mortality ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Large Scale ◽

Cohort Analysis ◽

Public Hospitals

Abstract Objective To report intensive care unit admission outcomes for head and neck cancer patients. Methods A retrospective, observational cohort analysis of all Australian and New Zealander head and neck cancer patient intensive care unit admissions from January 2000 to June 2016, including data from 192 intensive care units. Results There were 10 721 head and neck cancer patients, with a median age of 64 years (71.6 per cent male). Of admissions, 76.4 per cent were in public hospitals, 96.9 per cent were post-operative and 43.6 per cent required mechanical ventilation. Annual head and neck cancer admissions increased from 2000 to 2015 (from 348 to 1132 patients), but the overall proportion of intensive care unit admissions remained constant. In-hospital mortality was 2.7 per cent, and intensive care unit mortality was 0.7 per cent. The in-hospital mortality risk decreased three-fold (p < 0.001). Conclusion Head and neck cancer patients had low mortality in the intensive care unit and in hospital. Risk of dying decreased despite more intensive care unit admissions. This is the first large-scale cohort study quantifying intensive care unit utilisation by head and neck cancer patients. It informs future work investigating alternatives to the intensive care unit for these patients.

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Rehabilitation Needs of Head and Neck Cancer Patients and Stakeholders: Case Study

Frontiers in Oncology ◽

10.3389/fonc.2021.670790 ◽

2021 ◽

Vol 11 ◽

Author(s):

Maria Karampela ◽

Talya Porat ◽

Vasiliki Mylonopoulou ◽

Minna Isomursu

Keyword(s):

Head And Neck Cancer ◽

Service Delivery ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Healthcare Professionals ◽

Informal Caregivers ◽

Rehabilitation Services ◽

Rehabilitation Process

BackgroundThe incidents of Head and Neck Cancer (HNC) are rising worldwide, suggesting that this type of cancer is becoming more common. The foreseen growth of incidents signifies that future rehabilitation services will have to meet the needs of a wider population.ObjectiveThe aim of this paper is to explore the needs of patients, caregivers and healthcare professionals during HNC rehabilitation.MethodsThis paper reports the empirical findings from a case study that was conducted in a cancer rehabilitation center in Copenhagen to elicit the needs of HNC cancer patients, informal caregivers and healthcare professionals.ResultsFour areas of needs during the rehabilitation process were identified: service delivery, emotional, social and physical needs. Service delivery needs and emotional needs have been identified as the most prevalent.ConclusionsStakeholders’ needs during the rehabilitation process were found to be interrelated. All stakeholders faced service delivery challenges in the form of provision and distribution of information, including responsibilities allocation between municipalities, hospitals and rehabilitation services. Emotional and social needs have been reported by HNC patients and informal caregivers, underlining the importance of inclusion of all actors in the design of future healthcare interventions. Connected Health (CH) solutions could be valuable in provision and distribution of information.

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The role of healthcare professionals in HPV communication with head and neck cancer patients: A narrative synthesis of qualitative studies

European Journal of Cancer Care ◽

10.1111/ecc.13241 ◽

2020 ◽

Vol 29 (4) ◽

Author(s):

Mairead O’Connor ◽

Bernadine O’Donovan ◽

Jo Waller ◽

Alan Ó. Céilleachair ◽

Pamela Gallagher ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Healthcare Professionals ◽

Qualitative Studies ◽

Narrative Synthesis

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No reduction in complication rate by stay in the intensive care unit for patients undergoing surgery for head and neck cancer and microvascular reconstruction

Head & Neck ◽

10.1002/hed.21117 ◽

2009 ◽

Vol 31 (11) ◽

pp. 1461-1469 ◽

Cited By ~ 32

Author(s):

Emeka Nkenke ◽

Elefterios Vairaktaris ◽

Florian Stelzle ◽

Friedrich W. Neukam ◽

Michael St. Pierre

Keyword(s):

Intensive Care Unit ◽

Head And Neck Cancer ◽

Intensive Care ◽

Head And Neck ◽

Neck Cancer ◽

Complication Rate ◽

No Reduction ◽

Microvascular Reconstruction

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A Qualitative Study Exploring Patient, Family Carer and Healthcare Professionals’ Direct Experiences and Barriers to Providing and Integrating Palliative Care for Advanced Head and Neck Cancer

Journal of Palliative Care ◽

10.1177/0825859720957817 ◽

2020 ◽

pp. 082585972095781

Author(s):

Catriona Rachel Mayland ◽

Hannah C. Doughty ◽

Simon N. Rogers ◽

Anna Gola ◽

Stephen Mason ◽

...

Keyword(s):

Palliative Care ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Healthcare Professionals ◽

Psychological Needs ◽

Advanced Head ◽

Specialist Palliative Care ◽

Family Carers

Objectives: To report on direct experiences from advanced head and neck cancer patients, family carers and healthcare professionals, and the barriers to integrating specialist palliative care. Methods: Using a naturalistic, interpretative approach, within Northwest England, a purposive sample of adult head and neck cancer patients was selected. Their family carers were invited to participate. Healthcare professionals (representing head and neck surgery and specialist nursing; oncology; specialist palliative care; general practice and community nursing) were recruited. All participants underwent face-to-face or telephone interviews. A thematic approach, using a modified version of Colazzi’s framework, was used to analyze the data. Results: Seventeen interviews were conducted (9 patients, 4 joint with family carers and 8 healthcare professionals). Two main barriers were identified by healthcare professionals: “lack of consensus about timing of Specialist Palliative Care engagement” and “high stake decisions with uncertainty about treatment outcome.” The main barrier identified by patients and family carers was “lack of preparedness when transitioning from curable to incurable disease.” There were 2 overlapping themes from both groups: “uncertainty about meeting psychological needs” and “misconceptions of palliative care.” Conclusions: Head and neck cancer has a less predictable disease trajectory, where complex decisions are made and treatment outcomes are less certain. Specific focus is needed to define the optimal way to initiate Specialist Palliative Care referrals which may differ from those used for the wider cancer population. Clearer ways to effectively communicate goals of care are required potentially involving collaboration between Specialist Palliative Care and the wider head and neck cancer team.

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