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