When a team of the best providers from a full array of disciplines come together to collaborate on treatment, patient outcomes are improved, side effects are reduced, and patient care is expediated. At the University of Louisville School of Medicine, several faculty members form a transdisciplinary team to address head and neck cancers, a type of cancer that requires extremely complex treatment.

Combining radiation oncology, medical oncology, and otolaryngology-head and neck surgery, the transdisciplinary team involves each patient in the decision-making process for their individualized treatment plan. Many types of head and neck cancer require the integration of two or three types of treatment, and with many regimens that have time constraints, sitting down as a cohesive team to make the decision is not just best practice, but a testament to the care the team is determined to provide. Speech and swallow therapists and dieticians are also key members of the transdisciplinary team as they work to mitigate both acute and long-term side effects of treatment.

Radiation is part of the initial course of therapy for approximately 70-80% of head and neck cancer patients, requiring the expertise of Neal Dunlap, M.D., chair and professor of radiation oncology. Dr. Dunlap currently sits on the NRG Oncology Head & Neck Core committee, the largest cooperative study group for head and neck cancers in the United States. Dr. Dunlap’s participation in this committee translates to his involvement in a number of innovative national trials that are working to reduce treatment morbidity and minimize side effects in those being treated for head and neck cancer, including studies working to understand lymph node drainage patterns in head and neck cancer and novel drug combinations in the upfront treatment of head and neck cancer.

Dr. Dunlap notes a shift in head and neck cancers, as a growing number are caused by human papillomavirus infection (HPV), a virus that is commonly associated with cervical cancer. “As we see more HPV-related head and neck cancers, survival has become very good,” explained Dr. Dunlap. “The only problem is treatment morbidity is still significant. Current efforts to minimize side effects include limiting radiation volumes and radiation dosages, minimizing invasive surgeries, and targeted systemic therapy.”

Chemotherapies or immunotherapies are often used to augment the impact of radiation, or in cases where the cancer has metastasized. Rebecca Redman, M.D., professor of medicine at ULSOM, is an expert in managing head and neck cancers with medicine. Dr. Redman serves as the Deputy Director of Clinical Research at the UofL Health – Brown Cancer Center, where she oversees the Clinical Trials Program. She is the Principal Investigator of several clinical trials that are incorporating new, potentially less toxic treatments into the standard treatment for patients with advanced head and neck cancer. She also oversees several early-phase clinical trials that are placing a particular focus on patients who have not responded to standard treatments.

“Many of the recent advances in treatment of head and neck cancer involve the incorporation of immunotherapies, which are medications that help a patient’s immune system attack their cancer,” Dr. Redman shared.  “There have been a number of changes in treatment paradigms, with a focus on minimizing toxicity and long-term side effects.”

It is evident that transdisciplinary care is a necessity for the complexities of head and neck cancers. Coordinated teamwork ensures the best care for the patient by having input from all three perspectives based on the patient’s unique individual situation.

“As a head and neck surgeon, I strive to balance aggressively treating cancer while preserving function and appearance,” said Daniel Vinh, M.D., assistant professor of Otolaryngology-Head and Neck Surgery. “Advances in radiation, robotic surgery, and microvascular reconstruction have greatly improved our ability to protect vital functions like swallowing and speaking, while also achieving better aesthetic outcomes. New technologies, such as 3D virtual surgical planning and custom-made implants, allow for even more precise, personalized reconstructions. Guiding patients through every stage of their cancer journey and building lasting relationships with them is one of the most rewarding parts of my work.”

This year during Head and Neck Cancer Awareness Month, the transdisciplinary team encourages you to talk to your primary care provider about an annual examination of your head and neck. Early detection is key to mitigating the effects of head and neck cancer.