Evidence-based Series (EBS) 5-3 is ARCHIVED. The guidance for the organization of care has been updated; see 5-3ORG Version 2. The guidance for the clinical management of Head and Neck cancer patients is no longer current and should not be used to inform clinical decisions, but may still be useful for academic or other information purposes.# 
The HNMWG acknowledges that in some cases the available evidence listed above did not directly establish optimal strategies in the management of head and neck cancer. In such instances, the HNMWG drafted recommendations based on the collective expert opinion of the working group members. 

# Structure and Organization of the Head and Neck Management Recommendations

# A. ORGANIZATION OF CARE RECOMMENDATIONS I. Preamble
In order to ensure the provision of the highest quality of care for patients with head and neck mucosal malignancy, the working and consensus groups have developed a set of organizational standards and treatment recommendations. The organizational recommendations were developed to establish the minimum requirements to maintain a head and neck disease site program. The recommendations are intended to ensure that the proper equipment is in place, and that medical and support staff are experienced and properly trained. The recommendations establish standards for minimum new patient volumes for regional cancer centre disease site groups in an attempt to ensure that all patients have access to the highest standard of care available in Ontario.

# II. Teams
The teams will include a core team, primary care provider, and extended team. The care of patients with head and neck cancer should be coordinated among members of an experienced Core Team, comprised of a group of physicians and allied healthcare providers who will be responsible for the assessment, treatment, planning, management, survivorship, and rehabilitation of the patient. The Primary Care Provider will be responsible for the ongoing overall health of the patient and will offer supportive care after treatment. The Extended Team will be called upon by the core team to facilitate treatment, planning, management, survivorship, and rehabilitation of the patient. Members of the Teams must have training or experience managing patients with head and neck cancers.

# The Core Team Recommendation
- The Core Team is comprised of a group of physicians and allied healthcare providers who will be responsible for the assessment, treatment, planning, management, survivorship, and rehabilitation of the patient. - The care of patients with head and neck cancer should be coordinated among members of the core team, who include the following:

# Primary Care Physician
Recommendation  The primary care physician is not involved in the day to day treatment of the head and neck cancer patient but plays an important role in post-treatment supportive care and is responsible for the ongoing overall health of the patient.
(Source: HNMWG, Consensus 77%, Round 2)  Reconstruction expertise is required for the surgical management of patients with head and neck tumours and necessitates a fellowship-trained microvascular surgeon with specific training in head and neck reconstruction. 

# The Extended Team

# Histopathological Reporting
Pathologists are advised to use the CAP-CCO standards for reporting head and neck malignancies (5). (Source: CAP-CCO, Consensus 86%, Round 2)

# Nodal Metastatic Disease
The reporting of nodal dissections should include a description of the levels and structures included in the specimen, including number of involved and uninvolved nodes, level of these nodes, and the presence and location of extracapsular spread of tumour. (Source: SIGN and HNMWG, Consensus 83%, Round 1)

# Primary Site
Histopathology reporting of specimens from the primary site of head and neck cancer should include:
tumour site, tumour grade, maximum tumour dimension, maximum depth of invasion, margin involvement by invasive and/or severe dysplasia and margin dimensions, pattern of infiltration, and perineural involvement, The multidisciplinary team should include healthcare professionals skilled in feeding tube placement (percutaneous gastrostomy, gastrojejunostomy, nasogastric). (Source: SIGN, Consensus 82%, Round 1)
Feeding tube insertion should be considered for individuals initially presenting with one or more of the following: significant weight loss (greater than 5% in one month or greater than 10% in 6 months), BMI < 18.5, dysphagia, anorexia, dehydration, pain, or any other symptoms that interfere with the ability to eat. (Source: HNMWG, Consensus 96%, Round 2)

# Smoking Cessation
Patients should be provided with information about, and assistance with access to, drug therapy and counselling to stop smoking prior to and during treatment.
If no centre-based smoking cessation program exists, patients should be referred to their primary care physician. 

# Treatment of the Primary Tumour
All options for definitive locoregional treatment including radiation therapy, chemotherapy, and surgery should be discussed with the patient.
If an organ preservation (radiotherapy with or without chemotherapy) approach is to be utilized, follow-up and salvage surgery must be available.
Following surgical resection, postoperative adjuvant radiotherapy with or without chemotherapy should be considered where indicated.
(Source: HNMWG, Consensus 91%, Round 1)

# Treatment of the N0 Neck
Patients with a clinically N0 neck, with more than 20% risk of occult nodal metastases, should be offered prophylactic treatment of the neck, by appropriate selective or modified radical neck dissection or external beam radiotherapy. (Source: SIGN, Consensus 80%, Round 2)