Head and Neck Cancer (Alberta, Canada) (priority setting in association with the JLA)

The Top 10 Priorities

1. What is the best overall treatment combination or regimen (surgery, radiation, chemotherapy, immunotherapy) and dose/schedule for various head and neck cancers to achieve a good prognosis while minimizing undesirable treatment effects?
2. How can information and treatment be coordinated and planned in advance to better integrate the diagnosis, treatment and reconstruction/ rehabilitation process?
3. Are there advances in precision medicine (e.g., genetics, bio markers) that can help clinicians personalize treatment and predict outcomes based on the patient's unique bio-chemistry and genetic profile?
4. In patients who have problems chewing and swallowing (dysphagia) following treatment for head and neck cancer, what is the best way to rehabilitate and restore chewing/swallowing as much as possible?
5. How knowledgeable are community providers (such as family physicians, dentists, speech language pathologists) about the early signs and symptoms of head and neck cancer, and would provider education result in more routine screening or more thorough assessment of presenting signs/symptoms?
6. What is the psychological impact to patients and their families of head and neck cancer, what mental health supports are needed, and how are they best accessed and delivered to optimize treatment, recovery, resiliency and long-term quality of life?
7. For individuals with oropharyngeal cancer that is linked to HPV (human papilloma virus) infection, is it safe and effective to use less intensive or aggressive treatment than the usual treatments for cancer?
8. How can patients be better supported and educated upon diagnosis and throughout planning and treatment to ensure they are involved and fully informed about treatment options, decisions, outcomes and long-term impacts?
9. How do different head and neck cancer treatments differ with respect to patient distress or impact on quality of life, overall function, and pain management, and what can be done during treatment to prevent or minimize the impact?
10. Does vaccination for human papilloma virus (HPV) affect the rate or recurrence of cancer of the oropharynx (such as the middle of the throat, back of tongue, soft palate, tonsils), and if so, is there a case for routine HPV vaccination to prevent this type of cancer?

The following questions were also discussed and put in order of priority at the workshop:

11. What is the best way to prevent or reduce the effects of radiation and chemoradiation that are long-lasting, permanent or may worsen over time, such as radiation fibrosis?
12. Which test or method is the best way to screen for head and neck cancer, who should be screened, and which health professionals (doctors, dentists, etc.) should conduct screening?
13. Which new or alternative/ complementary therapies (such as acupuncture, herbal medicine, medical marijuana) can improve patient outcomes or reduce side effects?
14. To standardize and streamline diagnosis, which clinical criteria or findings should prompt family physicians and dentists to order further testing?
15. Which early signs and symptoms of head and neck cancer are recognizable to patients/families, and would public education programs lead to earlier detection of head and neck cancer?
16. How do delays in the assessment and confirmation of suspected head and neck cancer affect prognosis or outcomes?
17. What can be done to reduce the economic and financial burden associated with treatment and ongoing management, including support for uninsured services or extra expenses?
18. What are the causes of delays in the assessment and confirmation of suspected head and neck cancer (such as specialist wait times, diagnostic pathway) and how can these be addressed?
19. Which tests are most accurate when monitoring for local recurrence, such as magnetic resonance imaging (MRI) or CT, and which provider groups are best suited to arrange these tests?
20. How often and for how long should patients be monitored for local recurrence of cancer, and what is the role and effectiveness of annual screenings?
21. What methods and doses of radiation therapy are the least damaging to surrounding tissue?
22. What is the best way to treat head and neck cancer that has returned (recurring)?
23. To effectively reduce the risk of oropharyngeal cancer in the general population, which target groups, if any, should be a priority for HPV vaccination, including age, sex, lifestyle or other risk factors?
24. Does general screening for head and neck cancer, in people who don't have signs or symptoms, lead to earlier detection, diagnosis, and better outcomes?
25. Which lifestyle or sexual practices, such as number of partners or type of sexual activity, are most likely to increase or reduce transmission of the human papilloma virus (HPV) between partners and/or affect the risk of oropharyngeal cancer?