The following people are in this group:
The Head and Neck Cancer theme is led by Professor Steve Thomas.
We are recruiting people with head and neck cancer to a cohort study funded by the National Institute for Health Research (NIHR) programme on evidence-based health care for major congenital and acquired problems of the head and neck. The overall aim of this study, called Head and Neck 5000, is to evaluate the outcome of centralisation of services for head and neck cancer.
The programme has also run two Head and Neck Research Workshops (2009 workshop-PDF,6.7MB; 2010 workshop - PDF, 11.4MB) for researchers, users and clinicians in head and neck cancer to identify the important research questions that need to be answered and produce research strategies designed to answer these questions. We also ran a joint Cleft/Head and Neck Cancer User Involvement Workshop (2011 workshop - PDF, 5.08Mb) and a joint Research Symposium (2011 Research Symposium-PDF, 6.94Mb) in 2011.
Systematic reviews of quantitative and qualitative evidence in head and neck cancer will also be conducted and where appropriate findings will be translated into evidence-based practice guidelines.
The James Lind Alliance is an initiative jointly funded by the National Institute of Health Research and the Medical Research Council. It aims to help patients and clinicians work together to agree on which are the most important research questions in a particular clinical area. Professor Steve Thomas is working with the Priority Setting Partnership associated with head and neck cancer.
This study is funded by the British Medical Association Gunton Grant and is led by Dr Melissa Ke. Based on secondary analysis of data from the Hospital Episode Statistics and mortality data from the Office for National Statistics, this study aims to evaluate the extent of centralisation of surgical services for cancers of the head and neck, upper gastrointestinal, and breast in England, its effect on travel distance for people with cancer and to explore the use of a quasi-experimental study design (i.e. instrumental variable analysis) to measure the relationship between the centralisation of surgery and patient outcomes.
We conducted a survey to evaluate current care and service provision for people with head and neck cancer in the UK (Hughes et al. 2012). We sent self- report questionnaires to all cancer networks, clinical leads of oncology units and leads for multi-disciplinary teams (MDTs) We found that head and neck cancer care is increasingly being provided through a centralised MDT but that increased resources and further changes in practice will be required to implement current NHS Cancer Policy. We also found that teams need to improve recording of their decision making, discuss morbidity and mortality, and support recruitment to clinical studies.
We updated a systematic review to determine which surgical treatment modalities for oral cavity and oropharyngeal cancers result in increased overall survival, disease free survival, progression free survival and reduced recurrence (Bessell et al. 2012). The review found weak evidence that elective neck dissection of clinically negative neck nodes at the time of removal of the primary tumour results in reduced locoregional recurrence, but there is insufficient evidence to conclude that elective neck dissection increases overall survival or disease free survival compared to therapeutic neck dissection. There is no evidence that radical neck dissection increases overall survival compared to conservative neck dissection surgery.
We conducted a systematic review to investigate whether or not the centralisation of cancer services results in economies of scale, or is cost-effective, or increases the costs of accessing care for patients and their carers (Ke et al. 2012). Current evidence on the economic impact of centralisation of cancer services is limited and of poor quality. While existing evidence suggests that increasing surgeon volume can reduce cost-per-patient up to a point, this might be at least partly counterbalanced by diseconomies of scale in very high surgical volumes and by the increased costs of accessing care to patients and carers.
We examined recent trends in survival for people diagnosed with head and neck cancer in the South West of England, using data from the South West Public Health Observatory (SWPHO) cancer registry (Drugan et al. 2012). We found that over 2000 cases of oral, laryngeal and pharyngeal squamous cell carcinomas were diagnosed; crude total 5-year mortality decreased from 55% among people diagnosed in 1996 to 44% among those diagnosed in 2003, and improvements over time were most marked among those with late-stage disease and with pharyngeal tumours.
We conducted a systematic review of randomised trials comparing perioperative standard polymeric nutrition or no nutritional supplementation with immunonutrition in the treatment of head and neck cancer (Stableforth et al. 2009). The results of the review showed that perioperative immunonutrition was associated with reduced length of hospital stay but other outcomes were not improved. Furthermore, trials were small with incomplete reporting of outcomes. An adequately powered trial is required to substantiate benefit.
We completed a case-control study nested in a cross-sectional study in Papua New Guinea and two separate systematic reviews and have shown that chewing betel quid not containing tobacco was associated with increased risk of leukoplakia and oral cancer (Thomas et al. 2007; Thomas et al. 2008).