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Complex Head and neck cancer surgery specialist centres NSW

Criteria for a specialist complex head and neck cancer centre

A resection is surgery to remove the cancer from the head and neck area. Some of these operations can be very complex, and require a team of health care professionals with suitable experience performing this surgery and providing supportive care after surgery.[1]

Complex surgery includes the following three procedures; radial neck dissection, free flap and radical neck dissection and free flap.

International studies indicate that patient outcomes can be improved when complex head and neck cancer surgery is performed in centres that do a high number of these procedures.[2,3]

It is recommended that specialist centres for complex head and neck cancer perform 25 resections per year*

* This minimum suggested annual surgical caseload has been selected through a clinical advisory group process bringing together international evidence and expert consensus.

Multidisciplinary cancer care team

Patients with head and neck cancer may have one or more types of treatment, including surgery, chemotherapy, radiotherapy and targeted therapies.

The involvement of a multidisciplinary cancer care team is required.[4-6] This team brings together health care professionals from different specialties to discuss a patient’s cancer diagnosis and staging, and their treatment options. It also enhances communication and care co-ordination between the specialists involved in a patient’s care.

Australian and international studies state that patients overseen by a multidisciplinary cancer care team experience better outcomes after cancer treatment.[4-6]

Team members

The core members of a multidisciplinary cancer care team for complex head and neck cancers have been validated by the Head and Neck Cancer Clinical Advisory Group. These core members are:

  • Head and neck surgeon
    • ENT surgeon
    • General surgeon
    • Maxillofacial surgeon
  • Plastic and reconstructive surgeon
  • Medical oncologist
  • Radiation oncologist
  • Palliative care clinician
  • Pathologist
  • Radiologist/imaging specialist
  • Special needs dentist
  • Specialist nurse
  • Speech pathologist
  • Dietitian
  • Psychosocial support (liaison with psychologist or social worker).
Actions for Health Professionals

Actions for Health Professionals

Patient referral

Patients with a suspected or confirmed head and neck cancer should be referred to a specialist who is a member of a multidisciplinary cancer care team, and practices at one of the specialist centres listed below.

Involvement of a multidisciplinary cancer care team early in the cancer journey is recommended to ensure optimal assessment, care, and outcomes.

The Canrefer website allows you to find cancer specialists who are MDT members, and has information about cancer services, optimal care pathways, and patient resources.

Smoking cessation support

Evidence suggests that tobacco cessation following cancer diagnosis improves survival. It also reduces treatment-related complications.[7–9] Health professionals should discuss tobacco use with all patients and provide appropriate cessation support.

List of public specialist centres for complex head and neck cancer surgery

Local health district

Hospital

Annual average complex head and neck resection caseload

Jan 2017 - Dec 2018

St Vincent's Network

St Vincent's Public Hospital, Darlinghurst

51-100

Hunter New England

John Hunter Hospital

51-100

Western Sydney

Westmead Hospital

51-100

Northern Sydney

Royal North Shore Hospital

51-100

South Western Sydney

Liverpool Hospital

51-100

Illawarra Shoalhaven

Wollongong Hospital

25-50

South Eastern Sydney

Prince of Wales Hospital

25-50

Nepean Blue Mountains

Nepean Hospital

25-50

Sydney 

Royal Prince Alfred

*

  • Surgical caseload data sourced from Admitted Patient, Emergency Department Attendance, and Deaths Register (APEDDR) via Secure Analytics for Population Health Research and Intelligence (SAPHaRI), Centre for Epidemiology and Evidence, NSW Ministry of Health.
  • In-scope diagnoses: primary head and neck (C00.0-10.2, C10.4-14, C15.3, C30.0, C31.0-31.1, C32, C33); melanoma of skin of head and neck (C43.0-43.4 - only surgeries with an indicator of surgical complexity); non-melanoma of skin of head and neck (C44.0-44.4 - only surgeries with an indicator of surgical complexity); all other malignant neoplasms (excluding thyroid (C73))
  • In-scope procedures: 30247-00, 30250-00, 30253-00, 30255-00, 30256-00, 30259-00, 30275-00, 30294-00, 30294-01, 31423-01, 31435-00, 34148-00, 34151-00, 34154-00, 38453-00, 38453-02, 39640-00, 39642-00, 39646-00, 39650-00, 39700-00, 41545-00, 41548-00, 41581-00, 41728-00, 41779-01, 41782-00, 41785-00, 41785-01, 41834-00, 41837-00, 41840-00, 41843-00, 42539-00, 42542-00, 42543-00, 45596-00, 45597-00, 45599-00, 45602-00, 45602-01, 45605-00, 45605-01, 45611-00, 45720-00, 45720-01, 45720-02, 45720-03, 45723-00, 45723-01, 45723-02, 45723-03, 45726-00, 45726-01, 45726-02, 45726-03, 45729-00, 45729-01, 45729-02, 45729-03, 45731-00, 45731-01, 45732-00, 45732-01, 45735-00, 45738-00, 45741-00, 45744-00, 45747-00, 45752-00, 45753-00, 45754-00, 45755-00, 45863-00, 45873-00, 52120-00, 90138-00, 90679-00, 90679-01, 90679-02, 90679-03, 90680-00, 90680-01, 90680-02, 90680-03
  • Indicators of surgical complexity: 31423-01, 31435-00, 45562-00, 45562-01
  • The annual average surgical caseload is based on a two-year average, to account for annual variations in surgical volumes.

*Figures pending consolidation

List of private specialist centres for complex head and neck cancer surgery

Local health district

Hospital*

Annual average complex head and neck resection caseload

Jul 2016 - Jun 2018

Sydney

Chris O'Brien Lifehouse

201-250

St Vincent's Network

St Vincent's Private Hospital, Darlinghurst

51-100

Northern Sydney

Mater Hospital North Sydney

25-50

Western Sydney

Westmead private Hospital

25-50

Northern Sydney

Sydney Adventist Hospital

25-50

  • Surgical caseload data sourced from Admitted Patient, Emergency Department Attendance, and Deaths Register (APEDDR) via Secure Analytics for Population Health Research and Intelligence (SAPHaRI), Centre for Epidemiology and Evidence, NSW Ministry of Health.
  • In-scope diagnoses: primary head and neck (C00.0-10.2, C10.4-14, C15.3, C30.0, C31.0-31.1, C32, C33); melanoma of skin of head and neck (C43.0-43.4 - only surgeries with an indicator of surgical complexity); non-melanoma of skin of head and neck (C44.0-44.4 - only surgeries with an indicator of surgical complexity); all other malignant neoplasms (excluding thyroid (C73))
  • In-scope procedures: 30247-00, 30250-00, 30253-00, 30255-00, 30256-00, 30259-00, 30275-00, 30294-00, 30294-01, 31423-01, 31435-00, 34148-00, 34151-00, 34154-00, 38453-00, 38453-02, 39640-00, 39642-00, 39646-00, 39650-00, 39700-00, 41545-00, 41548-00, 41581-00, 41728-00, 41779-01, 41782-00, 41785-00, 41785-01, 41834-00, 41837-00, 41840-00, 41843-00, 42539-00, 42542-00, 42543-00, 45596-00, 45597-00, 45599-00, 45602-00, 45602-01, 45605-00, 45605-01, 45611-00, 45720-00, 45720-01, 45720-02, 45720-03, 45723-00, 45723-01, 45723-02, 45723-03, 45726-00, 45726-01, 45726-02, 45726-03, 45729-00, 45729-01, 45729-02, 45729-03, 45731-00, 45731-01, 45732-00, 45732-01, 45735-00, 45738-00, 45741-00, 45744-00, 45747-00, 45752-00, 45753-00, 45754-00, 45755-00, 45863-00, 45873-00, 52120-00, 90138-00, 90679-00, 90679-01, 90679-02, 90679-03, 90680-00, 90680-01, 90680-02, 90680-03
  • Indicators of surgical complexity: 31423-01, 31435-00, 45562-00, 45562-01
  • The annual average surgical caseload is based on a two-year average, to account for annual variations in surgical volumes.

*Private specialists centres listed have given permission to be included on the Cancer Institute NSW website.

References

  1. Department of Health and Human Services. Optimal care pathway for people with head and neck cancers. State Government of Victoria, Melbourne. 2015.
  2. Eskander A, et al. Volume–outcome associations in head and neck cancer treatment: A systematic review and meta-analysis. Head Neck. 2014. 36(12):1820-34.
  3. David JM, et al. Treatment at high-volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer. Cancer. 2017. 123(20):3933-42.
  4. Badran KW, et al. Is multidisciplinary team care for head and neck cancer worth it? The Laryngoscope. 2017. Nov 6.
  5. Brunner M, et al. Head and neck multidisciplinary team meetings: Effect on patient management. Head Neck. 2015. 37(7):1046-50.
  6. Licitra L, et al. Evaluation of the benefit and use of multidisciplinary teams in the treatment of head and neck cancer. Oral Oncol. 2016. 59:73-9.
  7. Karam-Hage M, et al. Tobacco use and cessation for cancer survivors: an overview for clinicians. CA Cancer J Clin. 2014. 64(4):272-90.
  8. Warren GW, et al. The biological and clinical effects of smoking by patients with cancer and strategies to implement evidence-based tobacco cessation support. Lancet Oncol. 2014. 15(12):e568-80.
  9. Florou AN, et al. Clinical significance of smoking cessation in subjects with cancer: a 30-year review. Respir Care. 2014. 59(12):1924-36.