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Palliative treatment standards for head and neck squamous cell carcinoma

Survey of clinical routine in German-speaking countries

Palliative Behandlungsstandards für Plattenepithelkarzinome im Kopf-Hals-Bereich

Umfrage bezüglich der klinischen Routine in deutschsprachigen Ländern

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Abstract

Background

The EXTREME (Erbitux in First-Line Treatment of Recurrent and Metastatic Head and Neck Squamous Cell Carcinoma) protocol is generally considered the gold standard in palliative first-line treatment. However, there is some disagreement about its effectivity, toxicity, and applicability in daily clinical routine. The purpose of this cross-sectional survey was to describe the palliative treatment offered in German-speaking countries.

Methods

From November 2013 to July 2014, 204 departments of otorhinolaryngology (ORL) in Germany, Austria, and the German-speaking parts of Switzerland were contacted and invited to take part in a web-based survey on the treatment of HNSCC.

Results

In all, 62 of 204 treatment centers (30.4 %) participated in the survey. Of these, 58 departments offered palliative systemic therapy to their patients; 19 of 58 (32.8 %) treated patients undergoing palliative chemotherapy in their own ORL departments, while 40 of 58 (69 %) upheld a cooperation with medical oncologists in the same hospital and 24 of 58 (41.4 %) with medical oncologic practices. Many of these treatment centers offered multiple locations for treatment. Of the 58 departments, 56 provided an institutional standard for first-line palliative treatment, 13 for second-line, and two for third-line treatment. In 42 of 58 departments the EXTREME protocol was the institutional standard of care for first-line treatment. Moreover, 12 of 58 departments mentioned an individual protocol and two of 58 the inclusion in clinical trials as their local standard. The assessment of patients who could be treated with the first-line standard ranged from 0 to 95 % with a mean of 44.5 %.

Conclusion

Palliative systemic therapy seems to be well standardized for first-line treatment, whereas there is little standardization in second- and third-line treatments. A large variation was found regarding the estimate of the applicability of the institutional standard. Reasons for this could be the physicians’ individual experience as well as the varying assessment regarding the toxicity of palliative systemic therapy.

Zusammenfassung

Einleitung

Für die palliative Erstlinientherapie wird meist das EXTREME-Protokoll als Standard angesehen. Es besteht aber Uneinigkeit über Effektivität, Toxizität und Anwendbarkeit in der klinischen Routine. Das Ziel dieser Querschnittsumfrage war die Darstellung der palliativen Behandlungslandschaft im deutschsprachigen Raum.

Methoden

Von 11/2013 bis 07/2014 wurden 204 HNO-Kliniken in Deutschland, Österreich und der deutschsprachigen Schweiz kontaktiert und zur Teilnahme an einer webbasierten Umfrage zur Tumortherapie von Plattenepithelkarzinomen im Kopf-Hals-Bereich (HNSCC) aufgefordert.

Ergebnisse

Von 204 HNO-Kliniken partizipierten 62 (30,4 %). 58 Kliniken bieten medikamentöse Palliativtherapien an. 19/58 Kliniken führen medikamentöse Palliativtherapien direkt in der HNO-Klinik durch, 40/58 kooperieren mit internistischen Onkologen in der eigenen Klinik, 24/58 mit niedergelassenen Onkologen. Viele Kliniken bieten mehrere Behandlungsorte an. Interne Behandlungsstandards halten 56/58 Kliniken für die Erstlinien-, 13/58 für die Zweitlinien-, 2/58 für die Drittlinientherapie vor. Als institutioneller Erstlinienstandard wurde von 42/58 Kliniken das EXTREME-Protokoll, von 12/58 ein individuelles Protokoll und von 2/58 der Einschluss in klinische Studien genannt. Die Einschätzung, wie viele Patienten den Erstlinienstandard erhalten können, reichte von 0–95 % mit einem Mittelwert von 44,5 %.

Schlussfolgerung

Unsere Umfrage ergab eine recht standardisierte Behandlung in der Erstlinientherapie, während Zweit- und Drittlinientherapie kaum standardisiert sind. Die Einschätzung der Anwendbarkeit der institutionellen Standardprotokolle variiert stark. Gründe dafür könnten einerseits die individuelle Erfahrung der Therapeuten, andererseits unterschiedliche Einschätzungen bezüglich der Toxizität der medikamentösen Palliativtherapie darstellen.

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Acknowledgements

We would like to thank all participating treatment centers for their time in completing this survey and their detailed responses.

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Authors and Affiliations

  1. Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Head & Neck Cancer Center Ulm, University Medical Center Ulm, Frauensteige 12, 89070, Ulm, Germany

    S. Laban, J. Kimmeyer, T. K. Hoffmann & J. A. Veit

  2. Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Head & Neck Cancer Center of the University Cancer Center Hamburg, University Medical Center Hamburg, Hamburg, Germany

    R. Knecht, C.-J. Busch, N. Möckelmann & T. Kurzweg

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  1. S. Laban
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  6. J. A. Veit
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  7. N. Möckelmann
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  8. T. Kurzweg
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Correspondence to S. Laban.

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Conflict of interest

S. Laban, J. Kimmeyer, T. K. Hoffmann, C.-J. Busch, J. A. Veit, N. Möckelmann, and T. Kurzweg state that there are no conflicts of interest. R. Knecht is a member of the scientific advisory board for Merck Serono, Sanofi Aventis, Boehringer Ingelheim, and Bayer Healthcare Leverkusen.

The accompanying manuscript does not include studies on humans or animals.

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Dieser Beitrag ist als eine Originalarbeit anzusehen und aus formalen Gründen im Leitthema dieser Ausgabe eingeordnet.

This article should be considered an original contribution and has been classified for technical reasons as a main topic.

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Laban, S., Kimmeyer, J., Knecht, R. et al. Palliative treatment standards for head and neck squamous cell carcinoma. HNO 64, 487–493 (2016). https://doi.org/10.1007/s00106-016-0187-x

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