Single Visit to Multidisciplinary Clinic Improved Efficiency of Head and Neck Cancer Care

Use of a single-day multidisciplinary clinic (MDC) visit allowed for more efficient and comprehensive cancer care in a group of patients with head and neck cancer, according to the results of a study published in JAMA Otolaryngology Head & Neck Surgery. Patients seen in the MDC had fewer instances of treatment delay, and faster and more frequent access to medical oncology, radiation oncology, and speech and audiology clinicians compared with a traditional clinic.

“We believe that this MDC approach facilitates improved efficiency and completeness of care via a single-day, single-appointment model,” wrote Melanie Townsend, MD, of Washington University in St. Louis, Missouri, and colleagues. “Its design stemmed from a desire to have relevant surgeons and medical oncologists simultaneously present to reduce bias toward a particular primary modality and to facilitate discussion.”

In the study, the researchers conducted a retrospective cohort analysis from June 2015 to July 2016 of outpatients at a single, academic medical center. Patients were seen in either the multiple appointment, traditional clinical (n = 73) or the single-day MDC (n = 68).

For patients seen in the MDC, “appointments were held in the surgeon’s clinic and were scheduled in new patient morning time slots,” the researchers explained. “The surgeons see MDC patients at a designated time and see regular clinic patients around that appointment to maintain workflow. The medical oncologists see the MDC patients back to back with the different surgeons and do not have any waiting time.” During lunch, a tumor board discussion takes place.

Included patients had new squamous cell carcinoma of the oropharynx, hypopharynx, sinonasal tract, and larynx. Patient factors and tumor characteristics were similar between the two groups.

There were significantly fewer delays (> than 30 days) from referral to treatment initiation in patients seen at the MDC (41% vs 59%) and from first appointment to treatment initiation (10% vs 23%). Patients seen at the MDC also had fewer median days between referral and treatment initiation (29 days vs 34 days) and between first appointment and treatment initiation (19 days vs 22 days).

“It was noted during analysis that a group of 23 patients in the traditional cohort who were treated with upfront surgery did not see medical or radiation oncology clinicians until after surgery, even though nonsurgical management was an alternative primary modality or was indicated in the adjuvant setting,” the researchers wrote.

When these patients were excluded, the time delays from referral to treatment between the MDC and this modified traditional cohort were significantly different (28 days with MDC vs 35 days with traditional; median difference, −5 days; 95% CI, −11 to −1).

“We believe this study provides evidence that this model is superior to a traditional, multiple-appointment approach in this regard,” the researchers wrote. “Future studies will investigate whether this clinic approach has a survival effect for patients.”