The treatment of head and neck cancer is complex. Significant expertise is required from a range of healthcare professionals because of the involvement of anatomically diverse areas (soft tissue, bones, skin, and a variety of glands and organs), as well, because of the vital functions affected by both the cancer and the treatment (breathing, chewing, swallowing and speech).
A number of organizations have recognized the need for guidance regarding the organization and delivery of healthcare services for patients with head and neck cancer. In Canada, Cancer Care Ontario's Program in Evidence-Based Care published such recommendations in 2019 1. These recommendations are largely an adaptation of the U.K.'s National Health Services, National Institute for Clinical Excellence Service's 2004 recommendations that are outlined in the document Improving Outcomes in Head and Neck Cancers. This document is the result of an extensive synthesis of the literature that has been translated into specific-practice oriented recommendations. 2 The Alberta Provincial Head and Neck Tumour Team has included the following tumour types in its mandate: head and neck mucosal tumours, salivary gland cancers, tumours extending in to the skull base from the head and neck (craniofacial cancers, sinus cancers, etc.), major non-melanoma skin cancers (requiring free flap reconstruction, neck dissection and radiation), invasive/complex thyroid tumours (requiring laryngectomy, pharyngectomy, tracheal resection, etc), and other malignant tumours involving the head and neck region. The Alberta Provincial Endocrine Tumour Team, in collaboration and consultation with the Alberta Provincial Head and Neck Tumour Team, will lead the development of clinical practice guidelines related to thyroid cancer. However, guidelines regarding the organization and delivery of care for patients with invasive thyroid cancer requiring complex surgery and/or external beam radiation will be developed by the Alberta Provincial Head and Neck Tumour Team.
The goal of this clinical practice guideline is to outline the recommendations for the organization and delivery of healthcare services for head and neck cancer patients in Alberta. In an effort to reduce duplication of work, Cancer Care Ontario's recommendations have been adopted and adapted with some customizations to better fit the Alberta context. The recommendations in this clinical practice guideline should be used as a guide rather than a fixed protocol. The implementation of this clinical practice guideline will depend on many factors besides the quality and credibility of the guidelines. Among those factors are sufficient funding to support full implementation and judgement used by healthcare professionals to form the multidisciplinary team and individualize care for head and neck cancer patients.

# Search Strategy
The biomedical literature was searched using the database PubMed. The search terms "head and neck neoplasm" and "organization and delivery" were combined using the Boolean operator term "and" to find publications pertaining to the chosen terms. Limits were not set for the search (e.g. language or publication type). As a result, 161 publications were identified. All abstracts were considered for possible inclusion. Publications that only described the effectiveness or feasibility of equipment, testing, or treatment, were not included in the evidence (e.g. endoscopic intubation with conventional plastic stents, intensity-modulated radiotherapy). After abstract review, 14 articles were reviewed in full and included in the evidence review.
The websites of prominent national and international clinical practice guideline developers were also searched for recommendations about the organization and delivery of health care services for head and neck cancers. In total, seven websites were searched in addition to the SAGE Directory (Standards and Guidelines Evidence) on The Canadian Partnership Against Cancer's website.  Target Population
The recommendations outlined in this guideline are intended for adults over the age of 18 years with head and neck cancer. Different principles may apply to pediatric patients.
These recommendations were adapted from: Organizational guidance for the care of patients with head-and-neck cancer in Ontario, 2019 1
 Physiotherapist 1, 2  Occupational Therapist 1, 2  Radiation Physicist 1, 2  Radiation Therapist 1, 2  Respiratory Therapist 1  Hyperbaric medicine 1  Home care team 1  Dermatologist
- Specific minimum qualifications are required of individual practitioners on the core team responsible for managing patients with head and neck cancer (Table 1). These qualifications were adapted from Cancer Care Ontario 1 and in some instances have been modified and expanded to reflect knowledge from practice experiences in Alberta.

# Cancer Centre and Team Member Volumes
- The management of head and neck cancer patients is complex. The initial phases of care and ongoing care of all head and neck cancer patients should be centered at a single, high-volume centre with adequate support and expertise to provide the highest level of care. - All patients with a new diagnosis of invasive head and neck cancer should be seen at a head and neck multidisciplinary clinic prior to initiation of treatment by the designated head and neck multidisciplinary team. These patients should subsequently be discussed at regularly scheduled Tumour Conference Rounds attended by the members of the core team to ensure consensus opinion on treatment and quality assurance. - Although the development of centres of excellence is strongly encouraged, innovative collaborations between high-volume and low-volume centres and/or regions should be expanded and defined in order to maintain the high quality of care being provided to head and neck cancer patients 2 after the initial management phases.
- The development of small-volume, non-multidisciplinary treatment programs for patients with head and neck cancer is strongly discouraged. 1
- There is data to support a volume quality relationship with higher volume centres having better outcomes.  However, no data exists in Alberta to directly inform minimum volume thresholds for surgeons, medical and radiation oncologists to ensure high-quality care. Thus, the Alberta Provincial Head and Neck Tumour Team, like Cancer Care Ontario 1 endorse the volumes recommended by the National Institute for Health and Clinical Excellence. 2 In addition, there are no data or clinical practice guidelines in Alberta or elsewhere to directly inform the minimum volumes for Specialized Oncology Nurses, Advanced Practice Nurses, Advanced Speech-Language Pathologists, Registered Dietitians and Social Workers. Note that in some cases minimum recommended volumes and FTEs have been modified and expanded by the Alberta Provincial Head and Neck Tumour Team to reflect knowledge from practice experiences in Alberta (Table 2 and 3).

# Multidisciplinary Care Requirements
- Head and neck centres will provide surgery, radiation, and systemic therapy.
- All head and neck cancer patients require a multidisciplinary assessment by a head and neck surgical oncologist and a radiation oncologist with expertise in head and neck oncological cases at a minimum and should receive assessment by medical oncology as needed.
Assessments can occur via multidisciplinary tumor board review or via in person assessment in a combined clinic.
- Where geography makes it difficult for patients to travel to be seen in person, assessment must include examination by an otolaryngologist/head and neck surgeon who is available in the local community. In addition, patients must be reviewed at a MCC with a head and neck surgical oncologist in attendance or by virtual review of the images and clinical examination by a head and neck surgical oncologist.
- The Head and Neck Oncologic Program must function within an acute care hospital and be affiliated with a regional cancer program. The program must have access to regular ambulatory care facilities, diagnostic and staging expertise and equipment, inpatient resources, and operating room access for cancer surgery.   Head and neck cancer patients should be seen by an experienced surgeon 10 as defined in Table 1 and 2, with access to the necessary diagnostic tools, and ideally within a multidisciplinary cancer clinic, within 2 weeks of referral,
- Urgent assessment by an experienced surgeon should be immediately available for any patient with a suspected head and neck cancer and critical symptoms (e.g. severe dysphagia, airway obstructions, stridor, etc). Primary Surgical Therapy from the ready-to-treat date to the start-of-treatment date for all eligible patients. In certain cases there may be clinical indication for more rapid access to treatment

# Team member
Minimum volumes required