Local attitudes in the treatment of low prognosis head and neck squamous cell carcinoma

Abstract

The incidence of head and neck carcinoma in Malta is 2.44 per 100,000 population, with 5-year survival rate of 20%. International studies have however shown that head and neck squamous cell carcinoma (HNSCC) carries an average 30% survival rate. The cost of treatment of low prognosis HNSCC patients in Malta is roughly €62,500 per year per person and considering that 7 patients out of those diagnosed are treated curatively annually, the total cost would increase to nearly half a million Euros per annum. In view of this, one is bound to ask the question whether not treating patients with a 30% survival rate is justifiable, especially in view that surgical and oncologic treatment can result in severe disfigurement and poses great physical and psychological stress on patients. No studies about local decision-making with respect to HNSCC have been published. This study set out to explore this issue from the ethical point of view, taking into account a number of variables with respect to treatment and the patient factors. A pre-determined set of questions was formulated and these questions were tackled by ten medical professionals, nine of which had direct contact with HNSCC patients. Issues such as informed consent, old age, quality of life, social variables, autonomy, healthcare rationing, medico-legal problems and past experiences with patients have been identified and discussed with reference to the local situation. It was noted that the majority of interviewed professionals (70%), still emphasised the need to provide full treatment for low prognosis HNSCC.