During 2006/2007 the National Head and Neck Cancer Audit has been able to capture good practice happening across England and Wales which results in an excellent standard of care, case ascertainment and data quality.

A number of good practice standards are detailed below, along with examples of organisations who have achieved good results.

• All trusts providing head and neck cancer care, whether diagnosing and/or treating should submit comprehensive and complete data to the National Head and Neck Cancer Audit.
  • Good practice examples:
    • The Newcastle Upon Tyne Hospitals NHS Foundation Trust
    • Royal Devon and Exeter NHS Foundation Trust
    • North Cumbria Acute Hospitals NHS Trust
• Data collection of care delivered along the whole patient pathway is a key requirement to understand the whole package of care. Networks are encouraged to facilitate this data collection.
• Recording cancer site and accurate stage is a key medical responsibility, with best practice suggesting that this should be clearly documented and captured at the MDT. Staging remains a key influence on outcome. It is important that this improves, to achieve 100 per cent of cases staged in any high quality database collection, to allow valid comparisons to be made.
  • Good practice examples:
    • Norfolk and Norwich University Hospitals NHS Trust
    • Derby Hospitals NHS Foundation Trust
• For those cases undergoing surgical management, it is important that resective pathological staging is accurately recorded to allow true stage comparison. Surgical teams should take responsibility in this area and, in particular, should ensure that the certainty factor is also accurately recorded.
• The expert panels are unanimous that all MDTs must ensure the recording of accurate staging information in 100 per cent of patients.
• The influence of factors such as co-morbidity and performance status can have a significant effect upon treatment outcomes. Therefore all MDT's are to be encouraged to collect these data set items to facilitate future risk adjustment.
  • Good practice example:
    • The Newcastle Upon Tyne Hospitals NHS Foundation Trust
• Patient expectations are that all care discussions are being made at a MDT, and head and neck cancer teams need to provide assurance around this important aspect of care.
  • Good practice examples:
    • Mid Yorkshire Hospitals NHS Trust
    • Northampton General Hospital NHS Trust and The Royal Wolverhampton Hospitals NHS Trust
• 100 per cent of diagnoses should be discussed at a MDT, currently in England and Wales only 74 per cent are recorded as having been discussed.
• A general theme of the analysis is that the second phase of treatment is not being well captured. This may reflect MDT data capture processes. Teams are encouraged to capture all parts of the patients' careplan.
• Synchronous malignancies of the chest can occur and have a significant impact on treatment options. Teams are encouraged to confirm that chest imaging has occurred in all head and neck cancer patients prior to planning treatment.
• Dental health, during and after treatment for head and neck cancer, is a significant contributor to patient well being. In oral cavity cancer proximity to the mandible or its direct involvement and the risks of ingress of infection following therapy, keep dental health as a high priority. MDTs are strongly encouraged to provide information to confirm that care is being provided.
• The absence of demonstration of appropriate speech and language support being provided to patients with laryngeal and oral cavity cancer remains a cause for concern, particularly in those undergoing major surgery. Active involvement of speech and language colleagues in the audit process is to be encouraged by all MDTs.
• Dietetic support is important through all parts of the patient pathway, particularly in those undergoing any form of treatment where the morbidity of the treatment can be reduced by appropriate support. MDT's are encouraged to confirm the dietetic care provided.
• Phase II of DAHNO has extended sections on surgical voice restoration and dietetic information. It is hoped that active involvement of all health professionals who care for head and neck cancer patients will be encouraged by MDTs to provide a comprehensive record of the multi-professional care provided.
• It is important that all components of a surgical procedure are recorded to provide a true reflection of the breadth and complexity of surgical management. Surgical voice restoration appears currently under-represented in the surgical procedures submitted.