Building a World-Class Head and Neck Program

Zvonimir L. Milas, MD, Head and Neck Cancer, Surgical Onocology

When Zvonimir Milas, MD, FACS, launched our head and neck cancer program in 2013, he expected its multidisciplinary approach to win attention from physicians and patients. But even Dr. Milas was surprised at how quickly the program became one of the region’s busiest.

Just five years after opening its doors, the head and neck program – which is part of Atrium Health’s Levine Cancer Institute – is attracting patients from across the Southeast. New patient visits for head and neck cancer, as well as endocrine cancer, have increased dramatically and now exceed 600 per year. Combined ablative head and neck cancer surgeries with reconstructive free-flap construction grew from less than 20 surgeries in 2013 to more than 120 cases in 2017.

“Our growth has been phenomenal, and we’ve expanded our team to reflect that,” Dr. Milas says. “We now have two head and neck surgeons, an endocrine surgeon, and two head and neck reconstructive surgeons.”

Delivering Comprehensive Treatment

Dr. Milas attributes the interest in his program to its multidisciplinary approach, which starts with having each patient see a head and neck surgical oncologist, a medical oncologist and a radiation oncologist. Every patient is also presented at a weekly head and neck tumor board that follows the latest National Comprehensive Cancer Network guidelines.

Patients are also seen by nurse navigators, speech therapists, social workers, nutritionists and rehabilitation specialists. Their input is especially important when treatments affect patients’ appearance, swallowing or speech.

“Our multidisciplinary approach allows for a thorough patient evaluation and gives everybody – especially the patient – a chance to hear different perspectives before we initiate treatment,” Dr. Milas says. “This means we can develop a comprehensive, personalized treatment plan that gives each patient the best chance at a great outcome.”

Top Outcomes

The head and neck program’s multidisciplinary approach is yielding outstanding mortality and morbidity rates for head and neck cancers and endocrine cancers.

These outcomes are gaining national attention: In 2015, the program was ranked for the first time, at 47^th, in the U.S. News & World Report rankings of otolaryngology programs. By 2017, we had climbed to 39^th.

“In five short years, we are being recognized for consistently delivering the standard of care for all head and neck malignancies, and we provide it in a manner that’s equal to – if not better than – any other cancer center in the United States,” Dr. Milas says.

Raising the Bar

Now Dr. Milas and his colleagues are working to make the program even stronger. They offer clinical trials of immunotherapy to eligible head and neck cancer patients and hope to add more trials soon.

The head and neck program is also implementing Enhanced Recovery After Surgery (ERAS) protocols, including multidisciplinary evaluations, preadmission patient education, perioperative nutritional care, anesthesia management and postoperative mobilization.

“ERAS has improved outcomes and decreased costs in our hepato-pancreato-biliary, colorectal and urology programs,” Dr. Milas says. “We have already implemented many of the principles of ERAS in head and neck surgeries; now we’re excited to start measuring these quality outcomes.”

Learn More

To learn more about our head and neck program, contact Dr. Milas at Zvonimir.Milas@atriumhealth.org.