Management of head and neck cancers

■ Over the next few years, assessment and treatment services for patients with head and neck cancers will become increasingly concentrated in cancer centres serving populations of over a million. ■ Multidisciplinary teams (MDTs) will be central to the service, each managing at least 100 new cases of upper aerodigestive tract cancer per annum. They will be responsible for assessment, treatment planning and management of every patient. Specialised teams will deal with patients with thyroid cancer, and with those with rare or particularly challenging conditions such as salivary gland and skull base tumours. ■ Arrangements for referral at each stage of the patient's cancer journey should be streamlined. Diagnostic clinics should be established for patients with neck lumps. ■ A wide range of support services should be provided. Clinical nurse specialists, speech and language therapists, dietitians and restorative dentists play crucial roles but a variety of other therapists are also required, from the pre-treatment assessment period until rehabilitation is complete. ■ Coordinated Local Support Teams should be established to provide long-term support and rehabilitation for patients in the community. These teams will work closely with every level of the service, from primary care teams to the specialist MDT. ■ MDTs should take responsibility for ensuring that accurate and complete data on disease stage, management and outcomes are recorded. Information collection and audit are crucial to improving services and must be adequately supported. ■ Research into the effectiveness of management – including assessment, treatment, delivery of services and rehabilitation – urgently requires development and expansion. Multi-centre clinical trials should be encouraged and supported.