12. Supply structures – Oropharyngeal and Hypopharyngeal Carcinoma

The patient should receive the best possible care in accordance with the latest medical knowledge. In order to achieve an optimal result in terms of functional preservation, quality of life and longevity, the cooperation of different experts is required. This presupposes that the patient is cared for at highly qualified centres (preferably certified head and neck tumour centres according to the German Cancer Society), in which he can be comprehensively informed about the treatment options of head and neck surgery, radiotherapy and internal oncology and in which or under whose coordination the chosen therapy (including psycho-oncological and phoniatric care) and rehabilitation can be implemented.

Since its inception 20 years ago, the DKG's certification concept in Germany has been supported by all specialist oncology societies and patient representatives and has been continuously developed on the basis of the guidelines. As of March 31, 2022, there were 1,778 DKG-certified centres, 148 of which were located abroad. The centres are represented at around 430 hospitals in Germany and in 2019, 56% of newly diagnosed patients were treated in a certified centre. According to the annual report of the Head and Neck Cancer Centres 2023, 11,299/year of primary head and neck cases in Germany (i.e. approx. 60% of the approx. 19,000 cases in total; HNSCC alone 18,000) are currently treated in 76 certified centres (DKG).

The WiZen results (effectiveness of care in oncology centres, Dresden Study 2022 based on approx. 1 million data sets from AOK routine data + data from clinical cancer registries [748] [749] [750]) show for the first time a clear survival advantage for almost all major cancer entities after treatment in certified centres. This study also included 15,287 patients with head and neck tumours from 2009-2017, 11,325 of whom were treated outside certified centres and only 3,962 within certified centres. A significant survival benefit after treatment in a certified centre was demonstrated. This effect remained stable, regardless of the overall size of the hospital. The advantage of centre treatment was clearer for patients with stages I-III than with IV. Across all stages, the advantage of having been treated in a certified centre was significantly different for a certification period of >2 years (HR0.9; CI 0.83-0.97) [749]. The differences in the subgroup of R0-resected patients with stage I-III head and neck tumours with regard to recurrence-free survival were impressive (HR 0.81; CI 7.2-9.2). The number 341, which is the calculated sum of avoidable cancer deaths 5 years after initial diagnosis through treatment in certified centres in Germany compared to treatment in non-certified facilities, states this drastically [750].

In cost-effectiveness analyses, other publications also point to the correlation between lower treatment costs for treatment in certified cancer centres compared to non-certified treatment structures in Germany (e.g. colon cancer [751] [752]).

The current findings indisputably speak in favour of concentrating the multidisciplinary care of patients with oropharyngeal and hypopharyngeal carcinomas in future on treatment facilities that meet the certification requirements of the German Cancer Society.

Primary care ENT physicians/specialists and general practitioners must also be involved in the care according to the respective phase of the disease in order to ensure optimal care. The patient's wish for optimal care can only be fulfilled by networking all the structures involved in the patient's care. The additional counselling offered by self-help groups is of great importance. All professional/self-help groups involved in the patient's care should therefore work together within the framework of network structures, through which the patient is guided in order to receive the appropriate care according to the respective phase of the disease. The coordination of patient care by the primary treating clinic (preferably a certified centre) but also the early involvement of patient self-help groups is of great importance.