Advent of the virtual multidisciplinary team meeting: do remote meetings work?

The multidisciplinary team (MDT) is key to the management and decision-making process for head and neck cancer. The sudden shift to virtual meetings due to the COVID-19 pandemic has been arguably the most dramatic change since inception of the MDT, and we know of no studies that have evaluated the head and neck MDT since this change in working. A preliminary questionnaire was designed and trialled, based on guidance on MDT qualities and measurable outcomes as per published national guidelines. A questionnaire was then distributed to all head and neck MDTs in the UK. We obtained 97 individual responses, from 27 units. Our results indicated that most clinicians (70.1%) felt that decision making was unchanged. Most (84.5%) also felt that technology resources were satisfactory and that some aspects of communication (viewing of images and slides) were as good or improved (76.3%). However, there were notable deficiencies with remote working. In particular, the majority of respondents perceived that engagement (43.9%), teamworking (69.1%), and training (47.7%) were worse since they moved to remote meetings. Our study suggests mixed opinions of virtual meetings. Our results demonstrate that despite remote working, head and neck MDT participants feel that they have largely been able to perform in most indicators. However, we should consider solutions to the perceived deficiencies in engagement, training, teamworking, and communication. To our knowledge, this is the first study to evaluate virtual head and neck MDT meetings, and the largest study of virtual MDTs and remote working within healthcare.

TRACHY score: a simple and effective guide to management of the airway in head and neck cancer.

Our aim was to provide a simple and effective scoring system to guide decision making in management of the airway. We retrospectively reviewed the casenotes of all patients diagnosed with head and neck cancer and who were treated by resection with primary flap reconstruction. Those factors that were significant (p<0.05) were analysed by logistic regression to establish their weighting. A total of 149 patients were included, 67 of whom (45%) were managed with endotracheal tubes, and 82 with tracheostomy (55%), of which eight were unplanned and late. From this we produced a score based on: T (T staging), R (Reconstruction), A (Anatomy of tumour), C (Coexisting conditions), H (History of previous treatment for head and neck cancer), Y (lateralitY- bilateral neck dissection). A score of 4 gave a sensitivity of 91.4%, a positive predictive value of 90.9%, a specificity of 90.8% and a negative predictive value of 88.2%. We applied this score to the patients, and it gave a mean score of: 2.1 (intubated), 5.7 (primary tracheostomy), and 4.6 (late tracheostomy). This is the largest published study to our knowledge of tracheostomies in head and neck cancer flap reconstructions that presents a scoring system for management of the airway. This scoring system can appropriately predict those patients who do not need tracheostomy and can act as a reliable screening tool in preoperative planning of the airway. It could aid management, and reduce the incidence of postoperative tracheostomies, with the potential that patients could be managed more safely, with reduced morbidity and mortality.