Establish intent of treatment

• Curative
• Palliative, which may include anticancer therapy to improve quality of life or longevity (or both) without expectation of cure, or symptomatic treatment only

Having access to specialist nursing and allied health disciplines (in particular specialist speech pathology, physiotherapy and dietetics) is important for managing the physical, psychological and social/practical needs that may arise with head and neck cancer treatment.

Surgery: Surgery can be used as the primary curative treatment modality in a number of head and neck cancers. It can be used to salvage residual or recurrent disease or as palliative treatment.

Radiation therapy: Radiation therapy can be used as the primary curative treatment in several head and neck cancers and may be given concurrently with systemic therapy. It can be given following surgery (postoperatively) for patients at high risk of locoregional recurrence. It can also be used as palliative treatment.

Systemic therapy: Systemic therapy, concurrent with radiation, can be used as the primary curative treatment or as an adjuvant treatment following surgery for several head and neck cancers.

Neoadjuvant systemic therapy (before radiation therapy) is also appropriate in a small number of specific clinical scenarios. Targeted biological agents and immunotherapy are the standards of care for some recurrent head and neck cancers. Systemic therapy can also be used as palliative treatment.

Palliative care: Early referral to palliative care can improve quality of life and in some cases survival. Referral should be based on need, not prognosis. For more, visit the Palliative Care Australia website.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient and/or carer where appropriate
• communicating the treatment plan to the patient’s GP
• helping patients to find appropriate support for exercise programs where appropriate to improve treatment outcomes.

Checklist

Timeframe

Surgery should be scheduled within 4 weeks of the MDM.

Radiation therapy or systemic therapy as a primary treatment:

• for curative intent – start within 4 weeks of the MDM
• for palliative intent – start within 2 weeks of the MDM.

If systemic therapy is being used concurrently with radiation therapy, start within 1 week of radiation therapy.

Radiation therapy as an adjuvant treatment should start within 6 weeks after surgery.