991PD - Defining best practices on supportive care during chemo-radiotherapy for head and neck cancer with a formal systematic methodology

Date 28 September 2014
Event ESMO 2014
Session Head and neck cancer
Topics Anticancer Agents
Supportive Measures
Head and Neck Cancers
Surgical Oncology
Biological Therapy
Radiation Oncology
Presenter Paolo Bossi
Citation Annals of Oncology (2014) 25 (suppl_4): iv340-iv356. 10.1093/annonc/mdu340
Authors P. Bossi1, E. Russi2, G. Numico3, V. De Sanctis4, N. Denaro5, M.G. Ghi6, A. Mirabile7, F. Moretto8, C.I. Ripamonti9, M. Buglione10, M. Airoldi11, J.B. Vermorken12, B. Murphy13, J.E. Raber Durlacher14, J. Langendijk15, L. Licitra7
  • 1Oncologia Medica, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 2Radiation Oncology, Azienda Sanitaria Ospedaliera S.Croce e Carle, Cuneo/IT
  • 3Hospital Of Aosta, Medical Oncology Unit, Aosta/IT
  • 4U.o.c. Radioterapia, Azienda Ospedaliere Sant'Andrea - Roma, 00189 - Roma/IT
  • 5Medical Oncology, Azienda Ospedaliera St. Croce e Carle, IT-12100 - Cuneo/IT
  • 6Medical Oncology Department, Ospedale dell'Angelo, 30174 - Venezia/IT
  • 7Head & Neck Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 8Radiation Oncology, AOU San Giovanni Battista Molinette di Torino, Torino/IT
  • 9Supportive Care In Cancer Unit, Hematologic And Pediatric Onco-hematologic Department, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 10Radiation Oncology, Università di Brescia, 25123 - Brescia/IT
  • 11Sc Oncologia 2, Città della Saluta e della Scienza - Torino, 10128 - Torino/IT
  • 12Department Of Oncology, U.Z.A. University Hospital Antwerp, 2650 - Edegem/BE
  • 13-, Vanderbilt School of Medicine, 37232 - Neshville/US
  • 14-, Academisch Centrum Tandheelkunde Amsterdam, - - Amsterdam/NL
  • 15Department Of Radiation Oncology, University Hospital Groningen (UMCG), Groningen/NL



Concurrent chemoradiation (CRT) is employed both in curative and postoperative settings in locally advanced head and neck cancer (HNC). The acute toxicity induced by this treatment is a major issue, affecting patients' quality of life and their compliance with timing and dose intensity. No guidelines exist for comprehensive best practices of supportive care (BPSC) to be adopted during this treatment.


Due to the lack of evidence from randomized controlled trials on most aspects of BPSC during CRT, an alternative approach to provide guidance was adopted. A formal consensus methodology was employed according to the model proposed by ASCO (Loblaw DA, J Clin Oncol 2012), through a modified Delphi strategy. Briefly, a consensus group of 40 experts including medical oncologists, radiation oncologists, surgeons, nutritionists, speech language pathologists, infectious disease specialists, dentists and nurses was constituted. A panel of facilitators for each topic performed a systematic review of the literature and a series of statements were defined. These were differentiated according to the timing of intervention (pre-treatment, during and after the treatment) and included an indication of the person in charge of the management of each BPSC aspect (e.g., physician, nurse, patient, caregiver). All experts rated these statements through a two-round process. A 4-point scale was adopted (1 = high consensus, 2 = low consensus, 3 = no consensus and 4 = unable to express an opinion). Consensus was defined as agreement by > 75% of raters. The statements were then finalized according to the suggestions of external reviewers. The process lasted from March 2013 to April 2014.


The following topics were included: mucositis, dysphagia, hematological toxicity, infections, nutrition and hydration, pain, skin toxicity and stomatological problems. Recommendations were delivered for each topic.


Practice guidelines for BPSC during CRT for HNC have been defined with a recognized methodology, in an area where high-quality evidence is lacking. The results of consensus as well as the areas identified for further consensus development will be presented. *Authors on behalf of the working group AIOM, AIRO, AIOCC.


All authors have declared no conflicts of interest.