Headline News 17/10/2019: Findings of ground-breaking new surgical trial on mouth cancer published by the British Journal of Cancer
The findings of the Selective Elective Neck Dissection (SEND study) funded by Elliott Bernerd (£600,000), Cancer Research UK, Robbie and Lisa Tchenguiz in memory of their mother Violet (£500,000), and Saving Faces, has been published for the first time in the British Journal of Cancer and has been recommended in the F1000 Prime as being of special significance in its field.
- Patients with mouth cancer benefit from additional surgery
- 30,000 more patients worldwide could be cured as a result of this finding
This work uses data provided by patients and collected by the NHS as part of their care and support.
Findings of research at 27 UK hospitals published in the British Journal of Cancer incontrovertibly show that removing the neck glands of patients at the same time as removing their small cancer in the mouth significantly improves their chances of cure even if the scans show no sign of deposits of cancer in the neck glands.
This major finding was only possible because of a national surgical collaboration in the UK by a team of 68 UK oral and maxillofacial surgeons treating 614 patients at 27 hospitals. It is the first-ever nationwide multi-centre study comparing 2 different surgical treatments for early mouth cancer. The large numbers of surgeons also means the findings are applicable to all surgeons and hospitals worldwide.
This finding clears up a longstanding medical dilemma which has never been completely resolved over many years to the satisfaction of national guidelines and expert surgeons. This UK-first has succeeded in studying enough patients to influence national guidelines.
The research was funded by Cancer Research UK, Elliott Bernerd and Robbie and Lisa Tchenguiz with Saving Faces. Elliott Bernerd (Saving Faces Chair of Trustees) says: “When I agreed to help fund this research, I hoped the results would help fellow cancer sufferers. This has exceeded my expectations and I encourage other people to support Saving Faces to help them change the future”.
Commenting on the findings, Professor Iain Hutchison, who co-wrote the paper with Professor Allan Hackshaw, research staff at Saving Faces and 32 surgeons:
“Mouth cancer is often neglected when it comes to research into finding better ways of treating it. We now have clarity over an issue which has vexed surgeons for over 20 years about how best to treat patients with small cancers who may have undetectable tiny cancer deposits in their neck glands. The results show that removing the lymph glands at the same time as the mouth tumour almost halves the chance of the cancer coming back or the patient dying. If all patients who are eligible for this operation have it, it could save 30,000 lives worldwide every year.”
“Surgeons now have reliable evidence about the risks and benefits of removing the neck glands in early stage mouth cancer. This provides better information to help surgeons and patients make decisions about their treatment. This is a good day for mouth cancer patients”.
The research also examined emotional, social and functional outcomes. There were no more frequent serious side effects or significant sociological disturbance to having the extra surgery of neck gland removal.
The SEND trial would not have been possible without the funding from Cancer Research UK, Elliott Bernerd and the Robbie and Lisa Tchenguiz, and access to the ONS mortality data delivered by NHS Digital.
Patient and Quotes:
To contact the patients. please ring Saving Faces or 020 3417 7757.
Maureen was randomised to receive removal of neck glands but patient only wanted removal of the mouth cancer.
Maureen says: “I agreed to participate in the trial. I should have had the mouth cancer and neck glands removed but I was too scared and vain to have such extensive surgery so I only had the mouth cancer removed. My surgery was 9 years ago in 2010. My husband and I stopped smoking and the cancer hasn’t come back. I speak and eat normally and have no scars”
Helen was randomised to only have the mouth cancer removed with no treatment of the neck glands. December 2014 Right-sided tongue cancer completely removed. March 2016 just over one year later developed a new cancer right tongue. Again completely removed. Clear of cancer for last 3.5 years.
Helen says: “the randomisation felt like a lottery not knowing what the outcome would bring. I was keen to do the study but was not so keen to have the neck dissection but my husband was keen. I think the word cancer is what makes it frightening but in some way the study was a distraction and a comfort to me as I felt I was giving back something.
When the cancer returned it affected me psychologically because I knew what I went through first time and I was anxious and frightened I would not get better. I think I got depressed as well as taking more time off work. My speech was also slightly slurred. I had some counselling sessions this time. First time around I didn’t really talk about the cancer and very few people knew why I was ill. After the counselling sessions I was able to be more open and speak about it which makes it more real and in a strange way less intimidating.
Overall I am proud to have been part of such a great research study. I can speak pretty clearly and eat normally now, I’m still working full time in the NHS.”
Ray was randomised to have the mouth cancer and neck glands removed at the same time.
Ray says: “I was warned that I might have speech problems, nerve damage in the neck and part of the face afterwards. I was in hospital for one week after the operation. During the first year afterwards I had difficulty raising my right arm above my shoulder but exercises and physiotherapy resolved this. I also had a speech problem but this improved quite quickly. I carried on working and essentially lead a normal life
Nationwide randomised trial evaluating elective neck dissection for early stage oral cancer (SEND study) with metaanalysis and concurrent real-world cohort
Iain L. Hutchison, Fran Ridout, Sharon M. Y. Cheung, Neil Shah, Peter Hardee, Christian Surwald, Janavikulam Thiruchelvam, Leo Cheng, Tim K. Mellor, Peter A. Brennan, Andrew J. Baldwin, Richard J. Shaw, Wayne Halfpenny, Martin Danford, Simon Whitley, Graham Smith, Malcolm W. Bailey, Bob Woodwards, Manu Patel, Joseph McManners, Chi-Hwa Chan, Andrew Burns, Prav Praveen, Andrew C. Camilleri, Chris Avery, Graham Putnam, Keith Jones, Keith Webster, William P. Smith, Colin Edge, Iain McVicar, Nick Grew, Stuart Hislop, Nicholas Kalavrezos, Ian C. Martin and Allan Hackshaw (2019)
British Journal of Cancer
Management of the clinically N0 neck in early-stage Oral Squamous Cell Carcinoma (OSCC). An EACMFS Position Paper
Journal of Cranio-Maxillo-facial Surgery
Reply to Comment(s) on “Nationwide randomised trial evaluating elective neck dissection for early stage oral cancer (SEND study) with meta-analysis and concurrent real-world cohort”
I. Hutchison and A. Hackshaw (2020)
British Journal of Cancer
More Evidence From a US Nationwide Cohort Study for the Survival Benefit of END in Early Mouth Cancer: Time for a Change in Guidelines
Iain Hutchison (2021)
Journal of the National Comprehensive Cancer Network (JNCCN)
About Saving Faces
The mission of Saving Faces-The Facial Surgery Research Foundation is to combat cancer, injury and disfigurement in the most socially important part of our bodies – the face and mouth.
Saving Faces is a unique charity. It is the only charity in the UK whose research focus is the face, mouth and jaws. Conditions such as cancer, disfigurement, infections and injuries interfere with our appearance and ability to eat and speak. Research into facial disease and deformity is essential and Saving Faces generates this research through its National Facial, Oral and Oculoplastic Research Centre (NFORC). This research improves the lives of thousands of people worldwide.
NFORC is a unique research centre. Saving Faces created the world’s first and only National Facial, Oral and Oculoplastic Research Centre (NFORC) in partnership with: The British Association of Oral and Maxillofacial Surgeons (BAOMS), The British Oculoplastic Surgical Society (BOPSS), The Cancer Research UK Cancer Prevention Trials Unit (CPTU) and The Royal College of Surgeons of England selected NFORC as its Head and Neck Research Centre.
Saving Faces is cost effective because:
- We partner surgeons (more than 350) at multiple hospitals across the UK and abroad. The cost of the research is low as the surgeons and patients give their time free-of-charge
- Patients are at the heart of the research selecting the most important studies with the surgeons.
- Patients contribute knowledge and experience and help with study design and implementation
- Saving Faces provides the scientists, statisticians and data managers to run the studies and analysis.