Surgeon-led multi-centre collaborative research in head and neck cancer : studies in remote triage, transoral robotic surgery for recurrent disease and consensus management in unknown primary disease

Abstract

Head and neck cancer (HNC) is newly diagnosed in around 1.5 million people each year, making it the sixth most common type of cancer worldwide. Some elements of HNC care are common and can be adequately investigated in a single institution setting and in a reasonable timeframe. However, for rare aspects, single institutions may not allow timely identification and recruitment of eligible patients, and so will struggle to be generalisable to the wider healthcare system. For these reasons, multi-centre studies are superior. Additionally, surgeons are often best placed to identify and recruit research subjects, as well as report on their clinical course. firstly, they have an intimate understanding of the patients under their care and so are ideally placed to understand the suitability of each subject to the research question at hand. Secondly, they understand their healthcare service and so the capacities and capabilities of the system they work within. Thirdly, they are on the front-line of healthcare delivery and so are more likely to encounter potentially eligible patients than research personnel working at a distance. This thesis explores the use of surgeon-led multi-centre collaborative research across three areas of HNC, tracking the patient journey: from referral as a suspected cancer; to diagnosis and management of unknown primary disease; and onto treatment with salvage surgery for recurrence. Presented over three parts and seven chapters, the included studies have engaged with every head and neck unit in the UK, with input from over 380 healthcare professionals. These works have culminated in the production of national guidelines, to meaningfully impact patient care, have secured over £3 million in funding for a future randomised trial of over 100,000 patients (the largest multi-centre study of HNC patients to date) and have reset the treatment paradigm for a subset of patients with recurrent HNC.