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Upper aerodigestive tract cancer

About

What is covered

This interactive flowchart covers the assessment and management of cancers of the upper aerodigestive tract in young people (aged 16 and over) and adults. It aims to reduce variation in practice and improve survival.
Who is it for?
  • People aged 16 and over with cancer of the upper aerodigestive tract, and their families and carers.
  • Healthcare professionals working in secondary and tertiary care.

Updates

Updates to this interactive flowchart

31 August 2017 Added cetuximab for treating recurrent or metastatic squamous cell cancer of the head and neck (NICE technology appraisal guidance 473) to oral cavity.
2 March 2017 Head and neck cancer (NICE quality standard 146) added.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on assessing and managing upper aerodigestive tract cancer in young people and adults in an interactive flowchart

What is covered

This interactive flowchart covers the assessment and management of cancers of the upper aerodigestive tract in young people (aged 16 and over) and adults. It aims to reduce variation in practice and improve survival.
Who is it for?
  • People aged 16 and over with cancer of the upper aerodigestive tract, and their families and carers.
  • Healthcare professionals working in secondary and tertiary care.

Updates

Updates to this interactive flowchart

31 August 2017 Added cetuximab for treating recurrent or metastatic squamous cell cancer of the head and neck (NICE technology appraisal guidance 473) to oral cavity.
2 March 2017 Head and neck cancer (NICE quality standard 146) added.

Quality standards

Head and neck cancer

These quality statements are taken from the head and neck cancer quality standard. The quality standard defines clinical best practice for head and neck cancer and should be read in full.

Quality statements

Nutritional status

This quality statement is taken from the head and neck cancer quality standard. The quality standard defines clinical best practice for head and neck cancer and should be read in full.

Quality statement

People with cancer of the upper aerodigestive tract have their nutritional status, including the need for a prophylactic tube, assessed at diagnosis.

Rationale

Many people with cancer of the upper aerodigestive tract lose a lot of weight as a result of the disease and its treatment; they often have difficulty eating. Assessing their nutritional status, including their need for a prophylactic tube, at the time of diagnosis will help to ensure adequate nutrition before, during and after treatment. This in turn will maximise the chances of people with cancer of the upper aerodigestive tract completing curative treatment.

Quality measures

Structure
Evidence of local arrangements and written clinical protocols to ensure that people with cancer of the upper aerodigestive tract have their nutritional status, including the need for a prophylactic tube, assessed at diagnosis.
Data source: Local data collection and HANA (Head and Neck Cancer National Audit), Saving Faces.
Process
Proportion of people with cancer of the upper aerodigestive tract who have their nutritional status, including the need for a prophylactic tube, assessed at diagnosis.
Numerator – the number in the denominator who have their nutritional status, including the need for a prophylactic tube, assessed at diagnosis.
Denominator – the number of people diagnosed with cancer of the upper aerodigestive tract.
Data source: Local data collection and HANA (Head and Neck Cancer National Audit), Saving Faces.
Outcome
Nutritional status of people with cancer of the upper aerodigestive tract.
Data source: Local data collection, for example, body mass index (BMI) levels and percentage weight loss, and HANA (Head and Neck Cancer National Audit), Saving Faces.

What the quality statement means for different audiences

Service providers (head and neck cancer secondary and tertiary care services) have systems in place to ensure that their teams assess nutritional status, including the need for a prophylactic tube, when cancer of the upper aerodigestive tract is diagnosed.
Healthcare professionals (members of head and neck cancer multidisciplinary teams) assess nutritional status, including the need for a prophylactic tube, when they diagnose cancer of the upper aerodigestive tract.
Commissioners (NHS England) ensure that they commission services which have systems in place to assess nutritional status, including the need for a prophylactic tube, when cancer of the upper aerodigestive tract is diagnosed.
People with cancer of the upper aerodigestive tract (the mouth, throat, voice box or sinuses) have an assessment when their condition is diagnosed to check their levels of nutrition and decide whether they need or might need feeding through a tube. Tube feeding can ensure that people who are finding it difficult to eat or drink get enough nutrients.

Source guidance

Definitions of terms used in this quality statement

Cancer of the upper aerodigestive tract
This encompasses cancers arising at different sites in the airways of the head and neck. These include cancers of the oral cavity, oropharynx, nasopharynx, hypopharynx, larynx and nasal sinuses.
[NICE’s guideline on cancer of the upper aerodigestive tract, full guideline glossary, appendix E]
Nutritional status
This is a person’s level of nutrition and includes weight loss, high or low BMI and their ability to meet estimated nutritional needs.
[NICE’s guideline on cancer of the upper aerodigestive tract, recommendation 1.7.1]
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Choice of treatment

This quality statement is taken from the head and neck cancer quality standard. The quality standard defines clinical best practice for head and neck cancer and should be read in full.

Quality statement

People with cancer of the upper aerodigestive tract are given the choice of either radiotherapy or surgery if both are suitable options for their type of cancer.

Rationale

People with cancers of the upper aerodigestive tract that have similar outcomes from radiotherapy and surgery should be told that both of these treatments are available and what they involve. This should include details of the potential side effects (including late effects). Clear explanation and support from healthcare professionals should help people with cancers of the upper aerodigestive tract to make a fully informed choice of treatment based on their preference and should increase patient satisfaction.

Quality measures

Structure
Evidence of local arrangements and written clinical protocols to ensure that people with cancer of the upper aerodigestive tract are given a choice of either radiotherapy or surgery if both are suitable options for their type of cancer.
Data source: Local data collection, National Peer Review: Head and neck cancer services, National Peer Review Programme and HANA (Head and Neck Cancer National Audit), Saving Faces.
Process
a) Proportion of people with newly diagnosed T1b–T2 squamous cell carcinoma of the glottic larynx who are given a choice of surgery or radiotherapy.
Numerator – the number in the denominator who are given a choice of surgery or radiotherapy.
Denominator – the number of people with newly diagnosed T1b–T2 squamous cell carcinoma of the glottic larynx.
Data source: Local data collection, National Peer Review: Head and neck cancer services, National Peer Review Programme and HANA (Head and Neck Cancer National Audit), Saving Faces.
b) Proportion of people with newly diagnosed T1–T2 squamous cell carcinoma of the supraglottic larynx who are given a choice of surgery or radiotherapy.
Numerator – the number in the denominator who are given a choice of surgery or radiotherapy.
Denominator – the number of people with newly diagnosed T1–T2 squamous cell carcinoma of the supraglottic larynx.
Data source: Local data collection, National Peer Review: Head and neck cancer services, National Peer Review Programme and HANA (Head and Neck Cancer National Audit), Saving Faces.
c) Proportion of people with T1–2 N0 tumours of the oropharynx who are given a choice of surgery or radiotherapy.
Numerator – the number in the denominator who are given a choice of surgery or radiotherapy.
Denominator – the number of people with T1–2 N0 tumours of the oropharynx.
Data source: Local data collection, National Peer Review: Head and neck cancer services, National Peer Review Programme and HANA (Head and Neck Cancer National Audit), Saving Faces.
d) Proportion of people with T3 squamous cell carcinoma of the larynx who are given a choice of either radiotherapy with concomitant chemotherapy or surgery with adjuvant radiotherapy, with or without concomitant chemotherapy.
Numerator – the number in the denominator who are given a choice of either radiotherapy with concomitant chemotherapy or surgery with adjuvant radiotherapy, with or without concomitant chemotherapy.
Denominator – the number of people with T3 squamous cell carcinoma of the larynx.
Data source: Local data collection, National Peer Review: Head and neck cancer services, National Peer Review Programme and HANA (Head and Neck Cancer National Audit), Saving Faces.
Outcome
Satisfaction with treatment for people with cancers of the upper aerodigestive tract that have similar outcomes from radiotherapy and surgery.
Data source: Local data collection and the National Cancer Patient Experience Survey, Quality Health.

What the quality statement means for different audiences

Service providers (head and neck cancer secondary and tertiary care services) ensure that people with cancer of the upper aerodigestive tract are told about both radiotherapy and surgery if they are both suitable options for their type of cancer. Discussion should include the potential side effects, and people should be given a choice based on their preference. If the service does not provide both treatment options, it should refer people to a local centre which provides the treatment they wish to have.
Healthcare professionals (members of head and neck cancer multidisciplinary teams) clearly explain radiotherapy and surgery to people with cancer of the upper aerodigestive tract if they are both suitable options for their type of cancer. This discussion should include the potential side effects, so that people can decide which they would prefer.
Commissioners (NHS England) ensure that they commission services which clearly explain radiotherapy and surgery to people with cancer of the upper aerodigestive tract if both are suitable options for the type of cancer. Discussion should include the potential side effects, and people should be given a choice based on their preference. Commissioners should ensure that the services commissioned either offer both radiotherapy and surgery or refer people to a local centre which provides the treatment a person wishes to have.
People with some cancers of the vocal cords are told what the different treatment options involve, including any side effects. This will help them to choose which treatment is best for them. If they choose a treatment that is not available at their local service, they should be referred to another local centre that can provide the treatment.

Source guidance

Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over (2016) NICE guideline NG36, recommendations 1.3.2, 1.3.3, 1.3.6 and 1.4.1

Definitions of terms used in this quality statement

Cancer of the upper aerodigestive tract for which radiotherapy or surgery are suitable options
These are:
  • newly diagnosed T1b–T2 squamous cell carcinoma of the glottic larynx
  • newly diagnosed T1–T2 squamous cell carcinoma of the supraglottic larynx
  • T1–2 N0 tumours of the oropharynx
  • T3 squamous cell carcinoma of the larynx.
[Adapted from NICE’s guideline on cancer of the upper aerodigestive tract, recommendations 1.3.2, 1.3.3, 1.3.6 and 1.4.1]

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Glossary

fluorodeoxyglucose positron emission tomography
human papillomavirus

Paths in this pathway

Pathway created: February 2016 Last updated: August 2017

© NICE 2017. All rights reserved. Subject to Notice of rights.

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