Head & Neck Cancer Program

INCIDENCE AND PREVALENCE

The National Cancer Institute estimates that 64,690 individuals in the United States will be diagnosed with head and neck cancer in 2018, accounting for 4% of all cancers. In recent years, infection with the Human Papillomavirus (HPV) has become a leading cause of some head and neck cancers – notably oropharyngeal – in a younger population.

PROGRAM OVERVIEW

Hoag Family Cancer Institute’s comprehensive Head & Neck Cancer Program integrates specialists in surgical oncology, medical oncology, radiation oncology, oral surgery, pathology, radiology, oncologic dentistry, speech language pathology, rehabilitation, dietary support, and genetic counseling. Maximizing patients’ quality of life and maintaining key functions such as speech, swallowing and taste are fundamental to patient-centered head and neck cancer care and priorities of Hoag’s program.

The Head & Neck Cancer Program is led by Medical Director, Timothy Kelley, M.D., a double board-certified minimally invasive head and neck surgeon, who specializes in head and neck surgery, skull base surgery and facial and plastic reconstructive surgery.

DIAGNOSTICS

Hoag is the first hospital on the west coast to of fer patients positron emission tomography/magnetic resonance (PET/ MR). This revolutionary hybrid imaging technique offers significantly enhanced imaging quality for cancer staging and location, allowing clinicians to more effectively plan surgery and treatment. PET/MR also means less radiation exposure for the patient.

Comprehensive tumor profiling is the standard for all advanced head and neck cancer patients at Hoag. Test results are discussed during the Head & Neck Tumor Board where the team collectively decides on a targeted drug or combination of drugs when actionable mutations are present.

TREATMENT

Tumor Board

The multidisciplinary Head & Neck Tumor Board convenes weekly to discuss patient cases. It is attended by surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, speech and language pathologists, oncologic dentists, dietitians, genetic counselors, and the program’s nurse navigator.

The Head & Neck Tumor Board meets every Wednesday at 12:30 p.m. at the Patty & George Hoag Cancer Center Newport Beach and via videoconferencing at Hoag Cancer Center Irvine. It is moderated by Brian Kim, M.D.

PET/MR post Yttrium 90 radioembolization to evaluate precise targeted treatment

Patients may also be eligible for a meeting with their treating physicians immediately following multidisciplinary tumor board conference to obtain immediate feedback on their consensus treatment strategy (See Second Opinions and Multidisciplinary Care Clinic below).

To submit a case for the Head & Neck Tumor Board, contact the Head & Neck Cancer Nurse Navigator, Rhonda Hjelm, M.S.N., R.N., O.C.N., at 949-764-1945 or [email protected] or Rosana Figueroa at 949-764-7044 or [email protected]

Surgery

The Head & Neck Cancer Program oncologic surgeons are subspecialty trained and maintain a high volume of cases, an advantage to patients not every program can deliver. They offer the full complement of head and neck surgeries and are skilled in minimally invasive and advanced surgery techniques including transoral endoscopic and transoral robotic surgery (TORS).

Close integration with plastic and reconstructive surgeons means the team can perform complex reconstructive head and neck surgeries including microvascular free flap reconstruction.

Medical Oncology

Concurrent chemoradiation is provided as the standard of care for patients who meet the criteria, and in some cases neoadjuvant therapy is used.

Recent advances in the understanding of the molecular basis of head and neck cancers have led to the availability of new and targeted therapeutic options, which are a part of patients’ treatment plans when actionable mutations are present. All advanced disease patients in Hoag’s Head & Neck Cancer Program have access to comprehensive tumor profiling through the Institute’s partnership with Caris Life Sciences. Recently, tumor genomic profiling results of several patients who presented with advanced or rare disease indicated actionable genetic mutations that led to an effective course of treatment that otherwise would not have been considered.

Radiation Oncology

Hoag’s Radiation Oncology department offers the full breadth of radiation therapies including Intensity Modulated Radiation Therapy (IMRT) using TomoTherapy HD, which delivers Helical IMRT, or Elekta VMAT modalities. The modality’s ability to vary the intensity of the radiation dose to the tumor helps minimize side effects in head and neck cancer patients.

Throughout their six to seven weeks of radiation, patients are seen weekly by a unique interdisciplinary care system that has resulted in fewer breaks in treatment and better overall outcomes.

Speech Pathology and Dietary Counsel

While most head and neck cancer programs refer patients to speech and swallowing therapy post radiation, Hoag’s patients participate in speech and swallowing therapy concurrently with radiation as well as post-treatment.

Dietary support is an essential component of comprehensive head and neck cancer care, yet few centers incorporate a specialized oncology dietitian in their programs. Hoag Family Cancer Institute has two oncology dietitians, who are key members of the Head & Neck Cancer team. They see patients at the beginning of treatment and work with them all the way through recovery to achieve optimal nutrition and maintain bodyweight, communicating with their physicians throughout. Studies show that patients who lose greater than 10% of their bodyweight during treatment have inferior outcomes. On average, Hoag’s patients lose only 6% of their bodyweight.

Second Opinions and Multidisciplinary Care Clinic

The Head & Neck Cancer Second Opinions and Multidisciplinary Care Clinic provides a pathway for newly diagnosed patients and those seeking second opinions to access multiple physicians in a timely and efficient manner. It was also designed to minimize the length of time to determine multimodality individualized treatment plans. After the nurse navigator obtains the patient’s pathology tissue and radiology exams for review, the patient is referred to the appropriate providers for physical exam and consultation. The case is then referred for review by the multidisciplinary Head & Neck Tumor Board. Immediately following, the patient meets with all physician specialists, the speech language pathologist and oncology registered dietitian in a virtual clinic model to discuss treatment recommendations. During the 12-patient pilot study from September 2015 - September 2016, the average length of time to treatment plan determination was seven days.

CLINICAL RESEARCH

Through the Institute’s Developmental Therapeutics Program in alliance with USC Norris Comprehensive Cancer Center, Hoag has opened several phase I and II clinical trials for which patients with advanced head and neck cancer are eligible. Early access to novel agents in clinical testing is a unique aspect of a community-based program and expands patients’ treatment options close to home. The following clinical trials have opened for patients with head and neck cancer. For a list of trials currently open, please contact Leila Andres, M.S., at 888-862-5318.


(106-16) 0S-15-5: A Pilot Multi-Arm Study of sEphB4-HSA in Combination with Different Chemotherapy Regimens in Patients with Specific Advanced or Metastatic Solid Tumors


(134-17) 0S-16-8: Phase IIa trial of sEphB4-HSA in combination with Anti PD-1 Antibody (Pembrolizumab, MK-3475) in patients with non-small cell lung and head and neck cancer


(214-17) OC-17-17 A Phase 1/2 First-in-human Study of BMS-986258 Alone and in Combination with Nivolumab in Advanced Malignant Tumors(Phase 1/2 clinical trial, appropriate for patients with advanced malignant tumors.


181-17/0C-14-2: An Open-Label, Phase 2 study of Neratinib in Patients with Solid Tumors with Somatic Human Epidermal Growth Factor Receptor (EGFR, HER2, HER3) Mutations or EGFR Gene Amplification


157-17/0C-18-2: A Phase I Study of FID-007 in Patients with Advanced Solid Tumors


114-17: A Randomized Phase II/Phase III Study of Adjuvant Concurrent Radiation and Chemotherapy Versus Radiation Alone in Resected High-Risk Malignant Salivary Gland Tumors

SCREENING AND HIGH RISK SERVICES

In April, during Oral Cancer Awareness Month, Hoag Family Cancer Institute hosts a free oral cancer screening for the community in partnership with ENT physicians.

Oral cancer screening is also an important part of regular dental exams. Hoag Family Cancer Institute’s Head & Neck Cancer team has made several presentations to the dental community on oral cancer. The program is integrated with local dentists through their participation in the Head & Neck Cancer Tumor Board.

SUPPORT AND EDUCATION

Rhonda Hjelm, M.S.N., R.N., O.C.N, Head & Neck Cancer Program nurse navigator, coordinates and navigates patients through multimodality treatment plans, provides education and emotional support to patients and their families, and is available to answer questions and address concerns.

The monthly Oral, Head & Neck Cancer Support Group facilitates connection, education and support for patients, their families and friends.

All head and neck cancer patients at Hoag have access to education classes, workshops, and other supportive and social services through Hoag Family Cancer Institute’s Integrated Cancer Support Services.

For more information call: 949-722-6237