A value framework in head and neck cancer care

Area of Science:

• Oncology
• Health Economics
• Patient-Centered Care

Background:

• Head and neck squamous cell carcinoma (HNSCC) care has shifted from single-modality to multidisciplinary approaches over 30 years.
• Increased treatment intensity has led to more demanding regimens for patients.
• A need exists to balance treatment outcomes with patient-reported trade-offs.

Purpose of the Study:

• To apply Porter's value model to HNSCC care, defining value as health outcomes per dollar spent.
• To incorporate patient-centered domains beyond survival, including functional recovery, sustainability, and long-term consequences.
• To include often-unmeasured outcomes like work disability and financial toxicity in the value assessment.

Main Methods:

• Utilized Porter's value model as a conceptual framework.
• Included patient-important domains such as survival, quality of life, functional outcomes, recovery, and lasting consequences.
• Considered work disability and financial toxicity as critical, though often unmeasured, outcomes.

Main Results:

• The value model framework allows for balancing survival, toxicities, cost, and trade-offs from the patient's perspective.
• Evidence supports de-escalation of care, intensity-modulated radiation therapy, advanced surgical techniques, and process improvements to enhance value.
• Patient preferences are essential for determining the most valuable treatment approach for individual HNSCC patients.

Conclusions:

• Integrating patient preferences into the value discussion is crucial for optimizing head and neck cancer care.
• A comprehensive value framework should encompass survival, functional outcomes, and financial toxicity.
• Future strategies should focus on de-escalation, advanced therapies, and patient-centered process enhancements to improve value in HNSCC treatment.