How We’re Enhancing Care for Head and Neck Cancer Patients

By David Adelstein, MD

It has been a year and a half since Cleveland Clinic’s new Cancer Center opened, leading to some important new programs that are enhancing patient care. The advantages of this shared physical space for all head and neck cancer patients and providers have become apparent, with greater patient convenience and caregiver collaboration. Our multidisciplinary program features the following programs.

Multidisciplinary care paths

Over the last decade, we have been working to create formal multidisciplinary patient care paths that define and consolidate treatment approaches for the major diseases we encounter. These algorithms are easily available to all caregivers at Cleveland Clinic and have allowed for greater standardization of our patient management. These care paths outline the best practices and workflows to treat specific conditions, and they are accessible to staff via Cleveland Clinic’s Intranet. More recently we have developed metrics, which can allow us to assess care path adherence in an ongoing way, to further ensure and maintain the quality of the cancer care we provide throughout the enterprise.

Patient liaison program

Our active Cancer Patient Liaison Program supports newly diagnosed cancer patients during this time of high anxiety and distress. The mission of our cancer patient liaisons is to guide each patient in traversing the myriad of tests, locations and physicians required to deliver modern cancer care. Our liaisons provide patients with a consistent resource for patient and family questions and issues as they arise and ensure that appointments are in line with metrics defined for each program.

Survivorship program

Perhaps one of the most impactful pieces of our multidisciplinary program has been the successful implementation of a robust survivorship program. Increasingly, our cancer patients are experiencing extended survival and cure after their diagnosis and treatment. Managing the long-term effects of both this diagnosis and its treatment requires a formal and supportive approach. Nurse practitioners from medical oncology, radiation oncology and surgery, working together, have organized to provide this service for all of our head and neck cancer survivors.

Our survivorship clinic integrates routine follow-up and survivorship care for head and neck cancer patients. Survivorship care is delivered by physicians, advanced practice providers (APPs), nurses, dieticians, dentists and speech pathologists. The care plans are created and delivered by three advanced practice providers who specialize in head and neck cancer—one from Otolaryngology, Medical Oncology and Radiation Oncology.

These care plans and treatment summaries are provided to all patients treated with curative intent within three to six months of completing cancer treatment. This is completed after post-treatment evaluation and/or imaging deems the patient to be disease-free. The program facilitates communication between patients, their treatment team, and the primary care provider (PCP), monitors and manages late toxicities and psychological needs, and standardizes surveillance for both disease recurrence as well as new second primary.

At the survivorship visit, the provider discusses an individualized oncology treatment summary with the patient, which includes diagnosis and staging information, treatment received, potential late effects from treatment. They also explain the anticipated follow-up schedule, including labs and imaging frequency. Patients receive written information about Cleveland Clinic and local community cancer resources, symptom-specific management and health maintenance recommendations. At the completion of this visit, the treatment summary is sent to the patient’s primary care provider (with patient permission).

The head and neck survivorship clinic was initiated in 2013 for patients with human papilloma virus (HPV)-induced cancers and has since been expanded to all eligible head and neck patients. Since 2013, approximately 550 survivorship visits have been completed.

Expedited care

Overall the new cancer center has allowed for greater ease of interdisciplinary referral and patient care decisions. Proximity makes a difference. Immediate formal and informal consultations are available from all practitioners. Now, a surgeon may be readily available and a diagnostic procedure can often be accomplished on the spot—or consultation with a radiation and/or medical oncologist can be immediately obtained. We have experienced countless examples of this since our opening in March of 2017.

This is all in keeping with the important focus of improving patient access and expediting care. We strive to see patients as quickly as possible after referral and to reduce the time between a cancer diagnosis and treatment initiation. Close interaction between caregivers is key to these efforts, and we are pleased to note that our new center, along with our new programs have markedly enhanced the efficiency of care delivery for our head and neck cancer patients.