Head and neck cancer (DAHNO)

The most common sites for head and neck cancer are the larynx (throat) and oral cavity (mouth). Head and neck cancer treatment requires a wide range of expertise, and treatment is usually discussed and agreed by multidisciplinary teams (MDTs).

Currently, the majority of patients are at an advanced stage of the disease when they approach the NHS, and provide a substantial and complex challenge to the managing team.

Aims of the Audit

The audit was developed as a result of the NHS Cancer Plan in 2001.

There is evidence of widely differing standards of care between different teams, but as yet there is no comprehensive mapping of care delivered. A variety of different specialties provide care, and the patterns of delivery vary. The audit allows national assessment of outcomes and provides a tool to improve the standard of care, identifying areas of good practice to teams delivering head and neck cancer care.

Measuring clinical care is notoriously difficult. Variations in casemix and resource have confounded attempts to identify good and bad practice. Establishing a national baseline is the first step in defining existing care delivery. Improving outcomes guidance (IOG) has produced a model of care delivery and 33 local delivery plans have been defined.

• Measures of compliance against the IOG document have been issued and a peer review process started in 2007.
• National audit provides a tool to assess compliance with these standards and identify resource limitations. Measuring clinical care is more than ticking boxes to achieve compliance. It should include a local re-appraisal of care delivery methods, and the ability to compare local standards and nationally derived figures is a significant advance.

Organisation of the audit  

The audit is being managed in England and Wales by the NHS Health and Social Care Information Centre under the National Clinical Audit Support Programme (NCASP), in collaboration with the British Association of Head and Neck Oncologists, the Department of Health and English cancer registries (represented by the East Anglia Cancer Registry).

The National Clinical Audit Support Programme at the NHS Information Centre 

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