Can smaller cancer centres deliver high quality care for patients with laryngeal cancer?
Reviewed by Madhup K Chaurasia

There is a continuing conflict between treating patients as close to their homes as possible and centralising specialised services, taking into consideration the critical mass and the multi-disciplinary expertise available. This is a report of outcomes in the treatment of laryngeal cancer in a small cancer centre serving a population of only 330,000, just about a third of what is recommended by IOG guidelines (2005). The authors looked at the survival rates of 209 consecutive patients, who presented with laryngeal cancer, over a 15 year period. These patients were prospectively entered into a standardised database. The distribution of these patients was as follows: 86 had stage one disease, 43 had stage two, 33 had stage three and 47 presented with stage four disease. A five year disease specific survival rate is reported as 100% for stage one, 76% for stage two, 87% for stage three and 46% for stage four. Of the 46 patients treated non-surgically 36 had recurrence of disease (79%). Most of these patients were treated surgically, before or after radiotherapy. The authors compare their five year tumour related survival rate of 82% and a five year overall survival rate of 59% with relative survival figures for laryngeal cancer across Europe ranging from 44% to 86%. This suggests excellent outcomes in a small cancer centre. An interesting review of the literature addresses the more recent trend for non-surgical treatment of laryngeal cancer, resulting in a non-significant decrease in the overall survival at five and 10 years. The authors attribute their 87% five year survival for Stage three disease to favouring surgical management of such advanced disease. The problems associated with radiotherapy and chemotherapy are mentioned and the role of surgery for advanced disease is supported. Less radical radiotherapy regimes are favoured. The article lends credence to the belief that laryngeal cancer can be managed reasonably well in a small, remote head and neck cancer centre, bringing care nearer to the patients’ homes.

Laryngeal cancer management in a small, rural, multi-disciplinary team setting: 15 year review.
Hamilton DW, McMeekin PJ, Dyson P, Robson AK.
JOURNAL OF LARYNGOLOGY AND OTOLOGY
2013;127:1203-7.