Factors Affecting Time Spent on Discussing Patients at a Tumor Board: The Ugandan Head and Neck Cancer Experience

Head and neck cancers are a varied group depending on the histopathological and/or anatomical definition one chooses to adopt. The oral cavity, oropharynx, nasopharynx, larynx and hypopharynx are most affected and often the histology is squamous cell carcinoma. Looking at them as a group their incidence worldwide varies dependent on gender, prevalence of smoking anatomic site and geographical region [1]. For instance oral cavity cancer age standardized rate (ASR) incidence is estimated at 6.9 in developed countries among men while it’s at 4.6 in developing countries. Laryngeal cancer ASR is at 5.5 and 3.5 in developed and developing countries respectively. In Uganda Nasopharygeal carcinoma ASR is estimated at 2.4 and 1.3 for male and female respectively with an annual increase of about 12.4% yet the data only covers a small county [2]. Thus showing the growing importance of head and neck cancers. Although the incidence ASR is lower in developing countries than developed, the ASR mortality is nearly equal showing the terrible prognosis these cancers portend in developing countries [3]. The reasons for this high mortality are multi-factorial ranging from late presentation, cultural beliefs, delayed referrals to appropriate health facilities and lack or frequent breakdown of facilities required in treatment of these cancers [4,5]. In addition to the few centers where such cases can be handled, most Sub Saharan African do not have concerted effort to have multi specialty teams and comprehensive pre treatment planning for both cancers and complex benign neoplasms. Multi disciplinary teams in cancer management have the advantages of offering the patients higher quality care in a more coordinated and timely manner [6]. Therefore they are being adopted as a standard of care in cancer management centers the world over.