The Juravinski Cancer Clinic, (formerly the Hamilton Regional Cancer Centre) is adjacent to the Juravinski Hospital, and serves as the cancer referral centre for Hamilton and the surrounding region, a total population of about two million people. Approximately 400 - 450 new patients are reviewed annually. Very few of these have thyroid cancers; as such patients are followed through surgeons' offices/clinics.
Each Friday morning, eight to ten newly referred head and neck cancer patients are seen by the team. This team consists of a head and neck surgeon, a radiation therapy oncologist, a resident and/or fellow in radiation therapy, a resident in Otolaryngology – Head & Neck Surgery doing an on-service rotation at SJHH, and three nurses. Each patient is seen by the designated members of the team, and the relevant imaging studies and pathology reports are reviewed. A team conference is held after all patients have been assessed, and through discussion a treatment recommendation is developed. The discussion usually involves decision-making parameters such as disease site and stage, pathology factors such as indicators of biologically aggressive disease, patient factors such as age, co-morbid conditions, previous treatment site(s) and modalities for head and neck cancer(s), social functioning and supports, addictions, reliability, consent and recommendations from the literature.
The Otolaryngology – Head & Neck Surgery resident is involved according to his/her level of training in evaluating patients and participating in the conference. This participation may include presenting the history, findings, imaging and pathology results, a summary of the site and stage of disease, and proposing a treatment outline. Once a consensus is reached, the treatment recommendation is then presented to the patient. Radiation therapy and chemo-radiation therapy take place at the JCC, whereas surgery is done at SJHH.
Friday afternoon clinics involve follow-up patients scheduled for review by their radiation therapist or surgeon. The Otolaryngology – Head & Neck Surgery resident sees patients independently and reviews them with the staff surgeon.
Such exposure gives the residents a good understanding of the spectrum of disease presentation and treatment outcome.