Multidisciplinary clinics (MDCs), if executed well, can foster collaboration by clinicians, minimize inconvenience for patients requiring appointments with multiple providers, and promote clarity for patients with complex treatment plans. Multiple models can be adopted for such clinics. Ideal models using provider time efficiently while serving patients have not been well-described. Our team’s experience with two clinic designs demonstrates multidisciplinary care that is feasible, sensitive to patient needs, and efficient for providers. In May 2015, our team initiated its first MDC for new H&N cancer patients referred by otolaryngology. Clinics were held during a 3-hour block twice a month. The format was modeled after well-established MDCs for breast and thoracic patients at our outpatient cancer center: patients were seen for initial consultations with a medical oncologist, radiation oncologist, dietitian, physical therapist, and social worker. Our H&N oncology nurse navigator coordinated the clinics and also met with patients. The goal was to enroll 4 patients per clinic prior to their start of treatment. In January 2017, we changed to a new model. The clinics continued to be held twice monthly with three key changes. First, physicians were eliminated from the clinics; they instead saw patients as soon as possible following referral receipt. Second, in addition to new patients, time slots were made available for patients in need of follow-up visits. Third, to reduce barriers to attending posttreatment appointments for speech and swallowing therapy, a speech-language pathologist was added to the MDC clinician team. The new model led to a 58% increase in average patient enrollment per clinic which translated to fuller clinics and better use of provider time. Patients needing follow-up with nutrition and speech-language clinicians accounted for 46% of attendees. Average patient attendance with the new model increased to 4.1 patients from 2.6 patients under the old model. Improved enrollment translated to a 39% absolute decrease in the rate of clinic cancellations. Elimination of physicians from the model allowed new patients to meet their oncologists outside the constraints of the MDC schedule. Ancillary providers could provide more concrete recommendations for patients given that treatment plans were already documented. Patient follow-ups to address quality of life, survivorship, and treatment toxicities were streamlined due to their inclusion in MDCs. Our novel MDC model is well-tailored for new and established H&N cancer patients. It efficiently utilizes patient and provider time and addresses the multiple physical and psychosocial needs that are unique to this complex patient population.

Treatment for head and neck (H&N) cancer can induce significant emotional and physical stress. Upon completion of treatment, patients are at risk for isolation, depression, and anxiety. Moreover, they cope with treatment side effects that have not resolved or are permanent, that is, a part of their “new normal”. Support groups and peer mentoring can benefit those with significant oncologic issues. However, strategies for the unique population of H&N cancer patients are not well documented. Our team designed a group seminar series to address their needs in the posttreatment setting. The program is modelled after the Finding Your New Normal (FYNN) series developed for cancer survivors at our facility. It is offered twice yearly and consists of a 5-week series, meeting once a week in the evening. Enrollment is open to patients and their caregivers who have completed treatment and limited to 16 attendees to facilitate an intimate atmosphere for sharing. Guest lecturers scheduled for specific sessions include a nurse practitioner survivorship specialist, radiation oncologist, dietician, speech language pathologist, physical therapist and psychologist. Representatives from a local YMCA and college attend and discuss, respectively, the Livestrong and Trail to Recovery programs offered by their institutions. A break-out session for patients and caregivers is included to allow them to meet in separate groups. In these safe environments, they reflect upon their respective experiences with peers. Sessions are co-facilitated by a licensed clinical social worker and the H&N oncology nurse navigator. Clinician presentations are brief to allow time for questions and round table discussions. Attendees fill out surveys following each of the 5 sessions to provide feedback and a final program evaluation. Since the initiation of H&N FYNN in 2016, 3 programs have been held with an average enrollment of 13 attendees. Survey results indicated the following rates of “strongly agree” for the four outcomes that were evaluated: Learned new information to deal with cancer experience: 83%; Better able to cope with cancer experience: 79%; Have an outlet to better handle stress: 76%; Feel that experience with H&N FYNN helps to live a better quality of life: 76%. Recurring themes of learning from each other, giving and receiving support, and an overall feeling of connection to the other participants were expressed in the comments. Addressing emotional stressors, as well as treatment-related toxicities, is a key aspect of survivorship for H&N cancer patients. Our FYNN series is rated highly by patients for improving their ability to cope posttreatment. It serves as a model for H&N cancer patients and can be customized for patients with other malignancies.

Background: Intracranial neoplasms can cause pain similar to trigeminal neuralgia. Literature regarding radiosurgery for this is limited. We present a retrospective review of patients with tumor-related facial pain from benign lesions treated with gamma knife radiosurgery (GKRS) at Wake Forest University. Objectives: The primary objectives were to determine long-term pain relief and predictive factors for pain alleviation. Methods: We reviewed 515 patients treated with GKRS for benign meningioma, vestibular schwannoma or trigeminal schwannoma between August 1999 and August 2010. Twenty-one eligible patients had tumor-related facial pain prior to GKRS. The median marginal tumor dose was 12 Gy. Long-term pain relief data were obtained by chart review and telephone interview. Results: The median follow-up for symptom evaluation was 3.8 years. Seventeen of 21 patients (81%) experienced a Barrow Neurological Institute (BNI) score of I–III at 6 months following GKRS. Kaplan-Meier estimates of freedom from BNI IV–V relapse were 66% at 1 year and 53% at 2 years. No pain relapses occurred after 2 years. Conclusion: GKRS of benign lesions is a noninvasive option for patients with tumor-related facial pain. Pain relief is modest, with the majority of pain relapses occurring within 2 years and approximately one half of patients maintaining relief beyond 2 years.

Objective: The objective of this study was to describe a simple model that predicts freedom from biochemical recurrence (FFBR) in men with Prostate cancer after treatment with low-dose rate prostate brachytherapy (LDRPB) alone.Materials and Methods: One hundred thirty-two men were treated with LDRPB alone between September 1997 and April 2001. Sixty-four percent of men had low-risk disease (prostate-specific antigen [PSA] <10, Gleason <7, and T stage = 10, Gleason >= 7, or T stage T2b). The dosimetric quantifier D-90 was calculated from a computed tomography scan performed 1 month after LDRPB. The percent positive biopsies (PPB) were determined for all patients. FFBR was estimated using the product limit method. All P values are 2-sided.Results: The median follow-up is 65 months. The median D-90 is 138 Gy (range, 47-221 Gy). Fourteen men have developed evidence of biochemical relapse at a median of 27 months (range, 6-42 months). The 5-year FFBR rate for the entire cohort is 88%. On univariate analysis, variables found to be associated with FFBR included: PSA, Gleason score, T stage, risk group, PPB, and D-90. Multivariate analysis indicated that D-90, PPB, and risk group were independently associated with FFBR. Patients were categorized based on the following 3 adverse prognostic factors: D-90 <140 Gy, PPB >= 50%, and intermediate-risk group. Group 1 (0 factors, n = 30), group 2 (1 factor, n = 72), and group 3 (>= 2 factors, n = 30) patients had 5-year FFBR rates of 100% (+/- 0%), 92% (+/- 6%), and 67% (+/- 18%) (P < 0.0001).Conclusions: We have developed a simple, robust model based on implant quality and disease factors that predicts FFBR in men with prostate cancer treated with LDRPB alone.