When it Comes to Head and Neck Cancer, Your Oncologist’s Experience May Make the Difference

The experience of a patient’s head and neck radiation oncologist may have a significant impact on their health outcome, according to a recent study published in the Journal of Clinical Oncology.

In the study, researchers identified radiation providers from Medicare claims of 6,212 Medicare beneficiaries with head and neck cancer treated between 2000 and 2009. They examined the impact of provider volume, or experience, on mortality from any cause, head and neck cancer mortality and toxicity after treatment with either conventional radiation or intensity-modulated radiation therapy (IMRT), a highly precise form of radiation therapy that has become the standard of care for the management of head and neck cancers.

Researchers found that with conventional radiation there wasn’t a noticeable relationship between provider volume and patient survival or toxicity after treatment. Among patients who underwent IMRT, those who were treated by radiation oncologists with more experience had better survival rates compared with low-volume providers. These patients also had lower mortality rates from head and neck cancers. The risk of mortality from any cause also decreased by 21 percent for every five additional patients a provider treated, which means the more experienced a physician, the better.

The study’s findings aren’t entirely surprising. There is a connection between a physician’s experience and a patient’s outcomes, though to what extent is unclear. At UF Health Cancer Center – Orlando Health Head and Neck Cancer Center, we see 300 consults a year for patients with head and neck cancers, and these patients have given us a breadth and depth of experience that helps nearly everyone we serve.

Experience is even more important than ever when you consider that human papillomavirus (HPV)-related head and neck cancers are on the rise. This is because more men are getting tonsil and tongue-based cancers as a result of HPV, a group of 150 related viruses transmitted during skin-to-skin contact and anal, oral or vaginal sex with someone who has the virus. Traditionally, smoking, tobacco and alcohol use have led to higher rates of head and neck cancers, which affect the mouth, throat, contiguous structures in the back of throat, tonsils, base of tongue, soft palate, salivary glands and pharynx. Globally, head and neck cancers are on the rise because more women worldwide are smokers. However, smoking rates have declined in the U.S., so an increased area of focus is these HPV-related head and neck cancers.

Radiation has been pillar of treatment for head and neck cancer. Traditionally, doctors used very broad radiation techniques to treat these cancers and the approach was to be big and not miss the tumor. However, this resulted in patients having very severe side effects, including a lifetime of dry mouth and taste loss and feeding tube dependency.

Over the years, we’ve tried to find techniques in the delivery of radiation therapy to finesse this treatment and reduce toxicity, but because these tumors are close to so many normal structures that can lead to severe toxicity down the line, radiation treatment for head and neck cancers often requires a certain level of experience. The radiation oncologist has to walk a fine line between causing toxicity and potentially under treating a patient’s cancer.

There’s a specific learning curve associated with giving radiation therapy to areas of the head and neck and still managing to cure patients. Physicians who treat these patients on a regular basis build a reservoir of experience that is invaluable to these patients and future ones they may treat. Research studies conducted in the 1990s were the first to prove this: centers that saw a lot of head and neck cancer patients had better outcomes compared to facilities that only saw a small number of these patients, giving truth to the phrase “practice makes perfect.”

By and large, there are a lot of places you can treat with radiation that are forgiving. But in the head and neck, there are many sensitive areas you try to avoid, including the spinal cord, salivary gland and swallowing musculature. If you don’t know how to treat these cancers effectively, you start getting more recurrence and severe, long-term side effects for patients.

The Journal of Clinical Oncology study indicates there’s a learning curve that affects patient outcomes. Another inference may be that centers that see a lot of head and neck cancer patients have a bigger team. You really need a robust system of ancillary team members to take care of patients. At our center, we have a very integrated head and neck oncology system. I work closely with three head and neck cancer surgeons, two medical oncologists, four speech pathologists and other radiologists and pathologists who also have a focus on head and neck oncology. Things that are rare to some doctors often aren’t rare to us because we see them on a daily basis.

You may have a single practitioner that only sees one of these cases a year, but we have a team that likely has seen several of these cases, giving these physicians more experience and expertise. It’s not solely this experience, but also the integration of care that really makes the biggest difference for patients.