“This is the next step in UIC’s multidisciplinary approach to head and neck cancer,” said Dr. Kristen Pytynia, assistant professor of otolaryngology.
The new clinic brings surgery and medical oncology together, making it easier for the patient to schedule a visit and allowing informal and immediate interactions between the specialists. The next goal will be to include radiation oncologists in the Thursday morning clinic.
The special challenges of head and neck cancer are “huge,” said Dr. Lawrence Feldman, associate professor of medicine in hematology/oncology.
“Our patients may not be able to eat, swallow, talk or even breathe,” Feldman said.
“I think often even doctors don’t appreciate all the challenges of these cancers,” he said. “Because of all the vital structures that are involved, treating head and neck cancer requires people with a lot of experience — we often get referrals because most community hospitals just don’t have the expertise to take care of these patients.”
In UIC’s comprehensive approach to head and neck cancer, the surgeon, medical oncologist and radiation oncologist each see the patient, then have a conference to determine the best approach.
To maximize both survival and quality-of-life, the team may bring in experts from fields including speech pathology, dentistry, oral surgery, plastic surgery and other services.
“We are concerned with managing and maintaining all the vital functions — speech, swallowing, breathing — both during and after treatment,” Pytynia said.
This approach is an important component of the long-term care the UIC clinic offers.
“Our involvement with patients is really a commitment to the rest of the patient’s lifetime,” Feldman said. The Clinic currently handles about 1500 patient visits a year, with plans to expand.
“We have two types of tumor conferences,” Pytynia said. The first is just for new patients. And once a week there is a tumor conference to go over every single patient who is on treatment just to make sure that everyone is on the same page.
Seventy-six percent of the tumors the clinic sees are advanced stage, Feldman said. The goal is to get patients on treatment within four weeks, then the initial treatment can take as much as four months — first surgery, with a six-week recovery period, followed by six to eight weeks of chemotherapy and radiation, then whatever other supportive services are needed.
If a tumor is going to come back, it will most likely do so in the first year, according to Feldman.
“We see patients pretty frequently right after they end their treatment,” he said. “About every six to eight weeks for the first year. Then we slowly ease back and by the time they are four or five years out from the original diagnosis, we’ll see them once a year.”
Almost all patients will have ongoing concerns.
“The multidisciplinary approach is so important because the physician can’t choose for the patient what’s important to them,” Pytynia said.
She described a patient who had two options: undergo chemotherapy and radiation and keep his voice box, or remove the voice box and possibly improve his swallowing. For the patient, the peace of mind knowing all the cancer was removed and being able to swallow was most important — more than trying to save the voice box.
“I think that’s something that we can’t choose for the patient,” Pytynia said. “And why it’s important to have all of us involved — to give patients all the options and let them decide.”
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