Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Aim: Sinonasal malignancies (SNM) are a heterogenous group of aggressive tumors treated with multimodality therapy. There is a critical unmet need to address optimal surveillance, including symptomatology and toxicity monitoring in survivors. Due to the rarity of these tumors, current survivorship guidelines are extrapolated from cancers involving other head and neck subsites limiting their specificity and effectiveness for SNM. This study aims to survey expert perspectives and develop consensus around three key survivorship tenets: surveillance, second tumor screening, and symptom management, with the ultimate objective to develop SNM-specific survivorship guidelines.
Method: Fifteen fellowship trained surgeons from high-volume North American academic centers were recruited. A series of initial statements was generated through literature review1. The experts ranked each statement by importance. Statements ranked as “very important” or “important” were then included in the Delphi Rounds. In the first Delphi round, experts scored each statement using a 9-point Likert scale where “1” represented “strong disagreement” and “9” represented “strong agreement”. A statement reached consensus if a mean score of ≥7 was achieved with no more than 1 outlier (defined as any score ≥2 Likert points from the mean in either direction), near-consensus if a mean score of ≥6.5 was achieved with no more than 2 outliers, and non-consensus if neither criterion was met. Initial responses were aggregated and analyzed. Participants discussed via video conference to revise near- and non-consensus statements for additional Delphi rounds. Further Delphi rounds were performed until consensus was reached.
Results: The survey completion rate was 14/15 (93%) for item generation and 15/15 for the two Delphi rounds. Experts agreed on the importance of endoscopy and MRI imaging for post-treatment surveillance for all tumor subtypes, as well as 3–6-month screening for local and regional recurrence in the first 3 years following treatment, with decreasing frequency afterwards. There was strong consensus on long term (>10 year) surveillance for olfactory neuroblastoma and adenoid cystic carcinoma, and 5-10 years for mucosal melanoma. Overall, the exact screening timeframes for distant metastasis was a key point that did not reach consensus across low-, intermediate- and high-grade tumors, although there was agreement for more frequent imaging for high-grade tumors. There was consensus on 13 statements that address regular screening for psychosocial and functional sequelae, such as changes to neurocognition, vision, hearing, pituitary dysfunction, speech/swallowing, neck morbidity, oral/dental health, and situational interventions such as initiating food and environmental safety counselling in patients with olfactory dysfunction. There was no consensus on screening for second primary tumors in SNM survivors. The expert panel initiated and arrived at consensus on the statement that patients would benefit from enrollment in survivorship programs to provide comprehensive post treatment care.
Conclusion: This study highlights the importance of histopathology-specific risk stratification for surveillance, and the need to recognize and provide resources for symptom and quality-of-life issues among SNM survivors. More research is needed to develop survivorship care programs and identify risk factors for second primary tumor screening.