Health care delivery for head-and-neck cancer patients in Alberta: a practice guideline

BACKGROUND

The treatment of head-and-neck cancer is complex and requires the involvement of various health care professionals with a wide range of expertise. We describe the process of developing a practice guideline with recommendations about the organization and delivery of health care services for head-and-neck cancer patients in Alberta.

METHODS

Outcomes of interest included composition of the health care team, qualification requirements for team members, cancer centre and team member volumes, infrastructure needs, and wait times. A search for existing practice guidelines and a systematic review of the literature addressing the organization and delivery of health care services for head-and-neck cancer patients were conducted. The search included the Standards and Guidelines Evidence (sage) directory of cancer guidelines and PubMed.

RESULTS

One practice guideline was identified for adaptation. Three additional practice guidelines provided supplementary evidence to inform guideline recommendations. Members of the Alberta Provincial Head and Neck Tumour Team (consisting of various health professionals from across the province) provided expert feedback on the adapted recommendations through an online and in-person review process. Selected experts in head-and-neck cancer from outside the province participated in an external online review.

SUMMARY

The recommendations outlined in this practice guideline are based on existing guidelines that have been modified to fit the Alberta context. Although specific to Alberta, the recommendations lend credence to similar published guidelines and could be considered for use by groups lacking the resources of appointed guideline panels. The recommendations are meant to be a guide rather than a fixed protocol. The implementation of this practice guideline will depend on many factors, including but not limited to availability of trained personnel, adequate funding of infrastructure, and collaboration with other associations of health care professionals in the province.

Prostate cancer in Saskatchewan Canada, before and during the PSA era

OBJECTIVES

The purpose of this study was to describe changes in the incidence of prostate cancer and in survival of diagnosed cases, as well as prostate cancer-specific mortality, during a period spanning the introduction of prostate specific antigen (PSA) testing in Saskatchewan in 1990.

METHODS

All cases of neoplasms of the prostate (ICD-O = C61.9) diagnosed in Saskatchewan from 1970 to 1997 inclusive, were identified in the Saskatchewan Cancer Registry. A subgroup of adenocarcinomas was defined for further study. Age-adjusted and age-specific incidence rates, and actuarial and relative survival were calculated according to time period of diagnosis. Age-adjusted and age-specific mortality rates from prostate cancer were also calculated for each time period, using Vital Statistics data.

RESULTS

The age-adjusted incidence of prostate cancer was 60.5 per 10(5) in 1970, rising gradually to 101.5 per 10(5) in 1989. In 1990, incidence rose much more sharply, reaching a peak of 163.1 per 10(5) in 1993, after which it began to fall. This sharp increase coincided with the introduction and increasing use of the PSA test in the province. Relative survival of prostate cancer patients was stable from the late 1970s through the 1980s, then improved markedly in the 1990-94 period. After the introduction of the PSA test, the relative risk of death for prostate cancer patients was only about 60% of what it had been throughout the previous 15 years. Prostate cancer-specific death rates did not change from the early 1980s to the end of the study period.

CONCLUSIONS

The above data are consistent with earlier diagnosis of prostate cancer due to PSA screening. Because mortality has not yet changed, it is premature to recommend widespread screening of asymptomatic men.

The use of radiologically placed gastrostomy tubes in head and neck cancer patients receiving radiotherapy

PURPOSE

Patients undergoing radiotherapy to the head and neck area frequently experience radiation reactions that can markedly restrict oral intake, require hospitalization, and occasionally cause treatment interruptions. The Vancouver Cancer Center (VCC) has recently employed radiologically placed gastrostomy tubes (G-tubes) in the management of this problem. A review of the patients on whom this procedure had been performed is the subject of this review.

METHODS AND MATERIALS

Thirty-four patients had gastrostomy tubes inserted under radiologic guidance. This group is compared to a control group matched for age, sex, irradiated volume, and radiation dose, who did not have gastrostomy tubes. Patients with gastrostomy tubes were divided into two categories: (a) patients who had tubes inserted in anticipation of severe reactions, and (b) patients who developed severe radiation reactions necessitating nutritional support.

RESULTS

The gastrostomy group consisted of 65% males with an average age of 59 years and stage range of II (12%), III (24%), and IV (65%). In both the elective group and the nonelective group, patients maintained their weight at 95 to 97% of the pretreatment weight, at follow-up of 6 weeks and 3 months. This compared with an average weight loss in the control group of 9% at 6 weeks and 12% at 3 months. The length of hospitalization was a mean of 4.9 days in the elective group and 19 days in the nonelective group. Complication were low compared to those documented in the literature, but included two tube migrations, two aspirations, and one gastrointestinal bleed.

CONCLUSIONS

We believe that gastrostomy tubes contribute significantly to the management of patients with head and neck cancer, particularly in maintanence of nutrition, and they may decrease the need for hospitalization.