The University of Texas MD Anderson Cancer Center Interdisciplinary Cancer Care Case Solution

2. What is the structure of the head and neck center? What activities, specialists, and facilities are included in the center? What activities are shared across multiple centers? Why?

Head and Neck Center was led by Dr. Ehab Hannah who was serving in a capacity of Medical Director and Vice-chairman of the Department. He was supported by in hierarchy by a medical and a radiation oncologist, Dr. Bonnie Glisson and Dr. Adam Garden who were Associate Medical Directors. This was one of the latest institutes to be created in 1996 by the hospital administration.

The Centre for Head and Neck was located on the ninth and tenth floor of the main building and due to its complicated nature and voluminous inflow of cases, there were separate waiting and reception areas for both surgical and medical oncology. Two hallways were dedicated entirely to the examination rooms where surgeons and oncologists met patients. Each hallway had a clinical staff workroom with a facility of taking and sharing notes for oncologists so that they can consult other doctors during in-between patient visits. Due to the complications often developed during the surgical procedures, patients often develop eating and speaking difficulties; therefore, full-time social workers have been hired for the counselling and therapy of patients post treatments.

3. How does the integration of care take place? What are the supporting mechanisms?

Till recently, health care was fragmented, and service delivery of care was rarely coordinated. However, with new research it has been established that seems delivery of healthcare is essential particularly in areas where the absolute cure is yet to be determined, for instance, cancer. The supporting mechanism is based on three particular aspects, which include continuity of information i.e. knowledge and records are shared across the board so as to allow simultaneous developments; continuity across secondary-primary care interface i.e. amount of time follow-ups should be maintained by oncologists before referring back to initial physicians; third, provider continuity i.e. consulting the same surgeon or clinician each time if there is a need in the form of therapy or counselling.

4. What factors have allowed the head and neck center (and other MCCs) to be successful at MD Anderson?

The primary factors to which success of Head & Neck Centre and other MCCs at MD Anderson can be pinned include the approach of adopting multidisciplinary care service, which allows variation in implementation procedure as per the cancer type and case’ complication level. A team approach allows consultation across the board so the diagnostic rate can be relatively higher. In addition to this, better communication is made possible as the structure of the center allows coordination among different departments. Moreover, even cases that were undertaken in geographically remote areas, the full therapeutic range was available for all patients. Furthermore, there is a constant effort to not just meet the nationally defined standards but to improve them through constant research and development.

5. Why is MD Anderson considering a new endocrine center? Does the idea make sense?

The idea of the new endocrine center was perceived at the top level based on the lack of facility for patients who came to MD Anderson with thyroid and parathyroid cancer. All these patients were redirected to Head and Neck Centre for surgery where they were managed by endocrinologists. The rationale behind investing huge amount in establishing a new center arises out of the large volume of thyroid and parathyroid patients.