Palliative treatment standards for head and neck squamous cell carcinoma : Survey of clinical routine in German-speaking countries.
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 %.


CONCLUSIONS
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.
Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Head & Neck Cancer Center Ulm, University Medical Center Ulm, Frauensteige 12, 89070, Ulm, Germany. simon.laban@uniklinik-ulm.de.
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Laban
Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Head & Neck Cancer Center Ulm, University Medical Center Ulm, Frauensteige 12, 89070, Ulm, Germany.
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Kimmeyer
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.
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Knecht
Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Head & Neck Cancer Center Ulm, University Medical Center Ulm, Frauensteige 12, 89070, Ulm, Germany.
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Hoffmann
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.
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Busch
Department of Oto-Rhino-Laryngology and Head & Neck Surgery, Head & Neck Cancer Center Ulm, University Medical Center Ulm, Frauensteige 12, 89070, Ulm, Germany.
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JA
Veit
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.
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Möckelmann
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.
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Kurzweg
D000328:Adult; D000368:Aged; D001317:Austria / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000592:standards; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards* / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D015995:Prevalence; D000077195:Squamous Cell Carcinoma of Head and Neck; D013557:Switzerland / Q000453:epidemiology
Clinical trial; Otorhinolaryngology; Palliative therapy, systemic; Squamous cell carcinoma, head and neck; Treatment protocols