American Head & Neck Society

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Published on by Johannes Fagan

African Head and Neck Society (AfHNS) Clinical Practice Guidelines for Head and Neck Cancers in Developing Countries and Limited Resource Settings

Members of the African Head and Neck Society and of the AHNS have been collaborating closely to promulgate resource appropriate clinical practice guidelines for cancers of the head and neck.

Head and neck cancers are principally a developing world problem, with developing countries accounting for 75% of head and neck cancers, and 80% of deaths from head and neck cancer. However, due to limited access to investigations and treatment such as cytology, imaging, (chemo)radiation, complex surgery, and even thyroid and calcium monitoring and replacement after thyroidectomy, international guidelines have limited value in resource limited settings. They can even be harmful, e.g. by rendering a patient hypothyroid after thyroid lobectomy, or hypocalcemic following total thyroidectomy when thyroid and calcium monitoring and replacement therapy are not available or affordable to the patient.

The AfHNS was established by a group of African fellowship-trained head and neck surgeons in 2016. It has benefited from the support of members of the AHNS in relation to teaching and training, research and scientific contributions to its annual conferences, and support of a scholarship for an AfHNS member to attend the annual AHNS meeting.

In December 2018 a task force comprising African, AHNS, and European head and neck and endocrine surgeons met in Cape Town to adapt the NCCN guidelines for evaluation of thyroid nodules and management of thyroid cancers and goitres in limited resource settings (Video). This led to the promulgation of resource-appropriate guidelines for thyroid tumours and large goitres in January 2019.

Subsequently guidelines have been promulgated for parotid and submandibular cancers, as well as for glottic, supraglottic and hypopharyngeal cancers. Oral cancer guidelines will be released soon, to be followed by other head and neck cancer sites.

These guidelines represent the combined expert opinions of head and neck surgeons in Africa and the USA and Europe, and precisely tailor the management of cancers of the head and neck according to available resources. They are directed not only at resident surgeons and oncologists in developing countries, but also at developed world surgeons undertaking short term humanitarian trips, such that they may better avoid providing inappropriate care. Promulgating these guidelines demonstrates the value that the AHNS can bring to addressing head and neck cancer in developing countries.

The African Head and Neck Society (AfHNS) Clinical Practice Guidelines for Head and Neck Cancers in Developing Countries and Limited Resource Settings can be found at the following websites:

https://afhns.org/

https://developingworldheadandneckcancerguidelines.com/

http://www.entdev.uct.ac.za/guides/open-access-atlas-of-otolaryngology-head-neck-operative-surgery

Respectfully,

Johannes Fagan MBChB, MMed, FCS (ORL)
Vice-Chair, AHNS International Advisory Service
johannes.fagan@uct.ac.za

Mark Zafereo MD, FACS
Chair, AHNS Global Outreach Service
Member AHNS International Advisory Service

Johannes Fagan

Johannes Fagan

Dr. Johannes Fagan is the Leon Goldman Professor and Chair of the Division of Otorhinolaryngology (ENT) at the University of Cape Town, Cape Town, South Africa. A major interest has been to advance head and neck surgery in Africa and the Developing World. He maintains an educational website for ENT surgeons in the Developing World (http://www.entdev.uct.ac.za/), and self-publishes two free textbooks, The Open Access Atlas of Otolaryngology, Head & Neck Operative Surgery and the Open Access Guide to Audiology and Hearing Aids. (http://www.entdev.uct.ac.za/guides/open-access-guide-to-audiology-and-hearing-aids-for-otolaryngologists). For his international contributions to otolaryngology he received the Nikhil Bhatt International Public Service Award from the AAOHNS in 2019, and a gold medal from IFOS in 2017 .
Mark Zafereo

Mark Zafereo

Dr. Mark Zafereo is an Associate Professor of Head and Neck Surgery at MD Anderson Cancer Center in Houston, Texas. He is Section Chief of Head and Neck Endocrine Surgery and Associate Medical Director of the Endocrine Center at MD Anderson Cancer Center. Dr. Zafereo holds national committee appointments for the American Head and Neck Society, American Academy of Otolaryngology-Head and Neck Surgery, and American Board of Otolaryngology-Head and Neck Surgery, and he is a Past President of the Houston Society of Otolaryngology-Head and Neck Surgery. He has published extensively on Thyroid and other Head & Neck cancers, speaking nationally and internationally. His clinical practice focuses on patients with thyroid cancer and parathyroid neoplasms.