NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
SCOPE
1 Guidance title

Improving Outcomes in Head and Neck Cancers

1.1 Short title

Head and Neck Cancer

2 Background

a. The National Institute for Clinical Excellence ('NICE' or 'the Institute') has commissioned the National Cancer Steering Group to develop service guidance on Head and Neck Cancer for use in the NHS in England and Wales. The guidance will provide recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness.

b. The Institute's service guidance will support the implementation of National Cancer Plan for England and the NHS Plan for Wales 'Improving Health in Wales'. The statements in the plans reflect the evidence that was used at the time they were prepared. The guidance published by the Institute after a plan has been issued will have the effect of updating the Plan.

3 Clinical need for the guidance

a. The aim of the cancer service guidance is to guide the commissioning of services. They are not clinical practice guidelines. The guidance concentrates on aspects of services that are likely to have a significant impact on health outcomes. Both the resource implications and the anticipated benefits of implementing the recommendations are considered. They can be used to identify gaps in local provision and to check the appropriateness of existing services.

b. They are used by Health Authorities, Primary Care Organisations and Acute Trusts to plan, commission and organise services for cancer.

4 The guidance

a. This document is the scope of the service guidance. It defines exactly what this guidance will (and will not) examine, and what the guidance developers will consider.

b. The areas that will be addressed by the guidance are described in the following sections.

4.1 Head and Neck Cancer Network and Multi-disciplinary teams

a. Multi-disciplinary teams

    i. The organisation of treatment services

    ii. Essentials for service provision in patients with head and neck cancer

b. Management plan through the specialist multidisciplinary team meeting (MDTM)

4.2 Referral, Diagnosis and Assessment

a. Diagnostic services for oral cancers

b. Appropriate and timely diagnosis and referral

c. Larynx/hypopharynx - rapid access clinics

d. Rapid referral of patients who are suspected of having a possible thyroid malignancy

e. Malignant cervical lymphadenopathy and the occult primary

f. Assessment and diagnosis of a lump in the neck

4.3 Treatment Services

a. Cancers of the mouth, nose and sinuses

b. Skull base and craniofacial tumours

c. Laryngo-pharyngeal cancer

d. Cancers of glandular origin

e. Issues relating to disfigurement

f. Altered routes of administration of drugs in dysphagic patients.

g. Issues relating to adequate control of pain.

h. Prevention of treatment complications

4.4 Post treatment follow-up and care

a. Post treatment follow-up

b. Effective rehabilitation

4.5 Prevention and Awareness

a. Raising awareness of the public and relevant professionals

b. Primary care assessment services, including opportunistic screening

4.6 Patient Centred Care

a. Patient involvement

    i. Patient involvement in the treatment plan and provision of patient information

    ii. Patient involvement and choice

b. Post treatment follow-up and care

c. Treatment services

d. Patient involvement in service planning

4.7 Palliative Care

Supportive and palliative care guidance is currently being developed under the auspices of NICE. Specific issues that will be addressed will be defined later in the editorial process, though potential topics include:

a. Patient concerns in relation to the risk of haemorrhage caused by invasion of the major vessels of the neck

b. Issues relating to end of life care.

c. Issues relating to adequate control of pain.

4.8 Audit support within guidance

The guidance will incorporate review criteria.

4.9 Status

The above questions were derived from a "Proposal Generating Event" which took place on the 21st and 22nd of February, 2001 in Harrogate, North Yorkshire. Those who attended included oncologists, maxillo-facial surgeons, otoz-rhino-laryngologists, oral medical specialists, general practitioners, general dental practitioners, public health physicians, palliative care physicians, nurses, radiographers, dieticians, occupational therapists and speech and language therapists. Importantly, the delegates to the conference also included patients who have been treated for a range of head and neck cancers.

The remit of those who attended the event was to highlight areas within the service that could be improved and to identify possible methods to deliver such improvement. Twenty-five individual proposals, many of which were very multi-faceted, were agreed upon. The proposals were grouped into nine topic areas called "Folders". These proposals were circulated to stakeholders for comment. The folders and the comments that have been made on them, were passed to the review team who will be responsible for conducting a review of the evidence which exists on some of the topics covered by the proposals. These are summarised in the scope above.

5 Further information

Information of the progress of the guidance will be available on the NICE website (www.nice.org.uk)