Benefits of optimizing cooperation in head and neck cancer care in a regional referral network

PURPOSE: Reducing the time to treatment improves outcomes, including survival, in patients with head and neck cancer (HNC). After implementing multiple local interventions to optimise organisation of HNC care in a large, recognized head and neck oncological centre (HNOC), this observational study evaluates changes in the diagnostic pathway before the first visit to our HNOC following the implementation of a regional referral agreement within a broader programme of care pathway optimisation. METHODS: All patients with newly diagnosed HNC in 2008 were compared with those diagnosed in 2016 before and after the agreement with referring hospitals to immediately refer patients based on clinical suspicion of cancer and refrain from any additional diagnostic procedures. RESULTS: Of the 559 patients with suspected HNC who were eligible for inclusion, 266 were included in 2008 and 293 in 2016. The time from the initial consultation with the referring medical specialist to referral to our HNOC decreased significantly from 16 to 11 days (median, p = 0.002). Overall, the interval from the initial consultation with the referring medical specialist to the start of treatment at an HNOC decreased from 56 days to 38 days (median, p < 0.001). Interestingly, this also resulted in a 47.6% decrease in rigid laryngopharyngoscopies and a 38.9% reduction in CT and MR imaging (p < 0.001). CONCLUSION: Following the care pathway optimisation, patients started treatment earlier, and the number of diagnostic procedures performed under general anesthesia decreased, reducing associated risks and costs. This study demonstrates that coordinated pathway optimisation at both network and tertiary-centre level may contribute to more efficient oncological care.