Optimal timeframes & summary

Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Head and Neck Cancer Working Group.

Timeframes for care

Step in pathway	Care point	Timeframe
Presentation, initial investigations and referral	Signs and symptoms	Presenting symptoms should be promptly and clinically triaged with a health professional
	Initial investigations initiated by GP	Signs and symptoms should be investigated if they persist for more than 3 weeks
	Referral to specialist	Specialist appointment should be within 2 weeks of referral
Diagnosis, staging and treatment planning	Diagnosis and staging	Performed under supervision of a member of a head and neck multidisciplinary team and should be conducted within 2 weeks of the specialist appointment
Diagnosis, staging and treatment planning	Multidisciplinary meeting and treatment planning	The first MDM should be within 2 weeks of receiving the diagnosis and staging results
Treatment	Surgery	Surgery should be scheduled within 4 weeks of the MDM. Time from definitive surgery to beginning adjuvant treatment (plus concomitant systemic therapy when indicated) should be not more than 6 weeks
Treatment	Radiation therapy +/- systemic therapy	If radiation therapy or systemic therapy is the primary treatment modality at the time from the MDM to starting treatment, it should begin within 4 weeks for curative intent and within 2 weeks for palliative intent If systemic therapy is being used concurrently with radiation therapy, it should begin within 1 week of radiation therapy Radiation therapy as an adjuvant treatment should begin within six weeks after surgery

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing recurrent, residual or metastatic disease

Step 7: End-of-life care

Head and neck cancer is the seventh most commonly diagnosed cancer in Australia (Koh et al. 2019). The estimated number of new cases of head and neck cancer diagnosed in Australia in 2019 was 5,212 (Cancer Australia 2019b). Head and neck cancer is more prevalent in males than females, with 3,807 males diagnosed and 1,405 females diagnosed in 2019 (Cancer Australia 2019b).

The pathway covers the following head and neck cancers: mouth or oral cancer; salivary gland cancer; pharyngeal or throat cancer, incorporating nasopharyngeal, oropharyngeal and hypopharyngeal cancers; laryngeal cancer; and nasal or paranasal sinus cancer. The pathway is also applicable to thyroid cancer, cancers of the cervical oesophagus, cancers of unknown primary that first appear in the head and neck, and cancer in the skin of the head and neck in the context of high-risk and advanced skin cancer.