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Welcome to UAB MedCast, a continuing education podcast for medical professionals, providing knowledge that is moving medicine forward. Here's Melanie Cole.

Melanie Cole (Host): Welcome to UAB MedCast. I'm Melanie Cole, and I invite you to join us as we discussed the UAB Oral Oncology Multidisciplinary Clinic. In this thought leader panel today, I have Dr. Anthony Morlandt. He's a head and neck surgeon, Head and Neck Surgical Oncology and Oral and Maxillofacial Surgery and he's also an associate professor. Dr. Michael Kase is a specialist in maxillofacial prosthodontics and the Assistant Director of the Advanced Education in Maxillofacial Prosthetics and Dental Oncology Fellowship. And Christina Cyriac, she's a physician assistant specializing in head and neck oncology. They're all with UAB Medicine.

Thank you all for being with us. I love when I do a podcast on the multidisciplinary approach, because this is the way medicine is advancing so greatly. Dr. Morlandt, I'd like to start with you and as we set the table here, can you tell us a little bit about oral cancer and why this care management model is a bit challenging for clinicians?

Dr Anthony Morlandt: Thanks so much, Melanie, and it's good to be with you again. Oral cancer is like I think just about every other type of human cancer in terms of its diagnosis and treatment in the sense that it requires not just one type of specialist, not just one type of practice, but a multitude of specialists from many backgrounds, many types of backgrounds. So our O'Neal Comprehensive Cancer Center here at UAB is widely known for incorporating leaders and specialists from many disciplines, whether it's medical oncology to deliver chemotherapy and immunotherapy or radiation oncology, and that couples in with our new Proton Therapy Center or the various surgical specialties. And then we have a number of additional services, ancillary type services, such as supportive care, speech-language pathology, physical therapy, occupational therapy, and an entire army of individuals to help manage patient's complex diseases.

I think one of the greatest reasons we have a very complex care model is because of the opportunities for cancer patients to live with a high quality of life and excellent survival is available now. And we can offer that here at UAB. In the past, I think for many cancers like oral cancer, the prognosis was dismal. Patients didn't have much of a chance of survival or a chance to have a reasonable quality of life, and so the treatment in a sense was simpler. But now, the treatments are complex because there's so much more to offer our patients.

Melanie Cole (Host): Dr. Morlandt, what type of patients are referred to the clinic and from where do these referrals come?

Dr Anthony Morlandt: Well, geographically, they come from all over the southeast. We're one of the largest head and neck cancer programs in the southeast. But we have not only the oral oncology clinic here at UAB, but we also have the otolaryngology service and we have a plastic and reconstructive surgery service as well. And so patients who end up in our clinics come from all of those disciplines and more. They may come first from a general dentist's office with a mouth tumor, that's then biopsied by an oral surgeon or an ear, nose and throat doctor or even a general surgeon or dermatologist, we see those too. And then they make their way into our clinics. So we're happy to see patients from any background or any discipline as far as the source of their referring doctor and we work with all types.

Melanie Cole (Host): Very well said. And so Dr. Kase, has this introduction of therapy involving multiple subspecialists and that utilization of a multidisciplinary team been really ideal for managing these complex patients? As Dr. Moreland said, head and neck cancer can really be devastating for a person's quality of life. Can you speak a little bit about the clinic itself and really how does it work as this multidisciplinary team?

Dr Michael Kase: Our clinic is very specialized related to oral oncology and the oral cavity. So, we tend to dedicate one clinic session a week for this multidisciplinary aspect where all aspects of our team end up seeing the patient. So we have the ablative surgeon, the reconstructive surgeon and myself, the prosthetic aspect, so we can develop this treatment plan where the patient will know exactly what's going to happen and everything that we're going to do to help this patient out as they go through everything.

Melanie Cole (Host): So, Christina, onto you, you're all representing different specialties here. And I imagine you work very, very closely with the patients. What are some of the effects of this type of cancer treatment for oral cancers? How does it affect the daily lives of patients, their families? And what are you finding the largest benefits of this multidisciplinary approach?

Christina Cyriac: So I'd first like to say that the multidisciplinary approach to cancer care and treatment is that a lot of our patients do not live in the Birmingham area, so they travel from all over the Southeast. So allowing them to see both the ablative surgeon, the reconstructive surgeon, as well as prosthodontist all in one day, limits their travel and strain coming to UAB for treatment. If you can imagine having to come back for three different appointments and living maybe four or five hours away, it has a lot of strain on not only the patient, but the family and the support system.

By combining these visits within our Oral Oncology Multidisciplinary Clinic, it allows our patients and families to only have to travel for one visit. This not only helps the patient, but also the families be there for the visit. As you can imagine, we are compassionate in understanding that our families work and have difficulty traveling to Birmingham if they do not live locally. And so patients are able to have the support they need during the clinic session.

Dr Michael Kase: I wanted to echo Christina's point there about how hugely beneficial it is to have all of us there, so the patient that drives from Mobile to Birmingham, that they get to see us all at the same time, in a matter of four or five hours, rather than it being protracted across two to three weeks. And not only does that benefit the patient, but it benefits us as providers because, now, instead of relying on notes being faxed over, instead of relying on other outside institutions telling us things about the patient and their treatment, we have it all in-house. So the communication is right here and we can all move forward cohesively and give the patient the best outcome possible.

Dr Anthony Morlandt: That's so true, Mike. And I think when patients have a diagnosis of cancer, it's scary and they want to be able to tell their family members, they want to tell the referring doctor what they learned at UAB. And so, what we really aim to do is send that patient home with some confidence and some comfort about the next steps moving forward. And so by giving them as much information as possible from our unified voice, our unified cancer treatment algorithm, I think it helps, I think it helps manage the burden of the psychological struggle that patients go through with a new diagnosis of head and neck cancer.

Melanie Cole (Host): What an excellent model of care this is. Really, you are leaders in the field. Christina, what does this clinic do that makes it unique? At UAB, you work with these families, what are they saying to you about this type of multidisciplinary care and what you're doing to go above and beyond? Because obviously, compassion and passion for your job is obvious here, so speak about what that means to patients, what they've said to you.

Christina Cyriac: We provide high quality and compassionate care here at UAB in our oral oncology clinic. I personally treat every patient as if they were one of my own family and want to provide the care I would want to receive in the time of a diagnosis of something like cancer.

One of the unique things we have here at UAB is we have developed a head and neck cancer support group. This support group is not only available for patients but families. We meet six times a year, both in person and via Zoom. With the COVID pandemic ever evolving, right now we're only meeting via Zoom, but this makes it easier for our patients and family members to get involved and get in touch with other patients who are also going through this. When you're first diagnosed with oral cancer, you have those initial steps to get through, what is my diagnosis and my prognosis and what treatment options are available to me?

Once a patient comes through our clinic and understands their different treatment options and opts to go forward with surgery, they then have the treatment side effects and sometimes adjuvant treatment that they have to undergo. The support group allows patients to discuss different tips and tricks and just have overall support through the cancer diagnosis.

Melanie Cole (Host): Dr. Kase, as Christina is talking about working with the patients, I imagine with any cancer, of course, the fears of the medical and the financial side, not to mention the devastating effects that an oral cancer can have on someone's appearance and ability to swallow, eat, speak, all of those things. In your role in this multidisciplinary team, does medical insurance cover the dental aspects of multispecialty oral cancer care? What about high cost implants? You and I have done other podcasts on implants and radiation therapy. Tell us a little bit about where insurance comes in for your part in this care.

Dr Michael Kase: Well, I will definitely say that our team has dedicated billing professionals that help give the patient all the information they need in terms of what is covered or is not covered. And in my opinion, our staff does the best job possible. And if there's a way to get it covered, they'll get it covered. But speaking on regards to what I do, the prosthetics, I will say that, again, with the help of our staff, more often than not, we get these prosthetics covered due to the fact that they relate specifically to a medical problem. So it's not just a denture, it's an obturator. It's not just a lower denture, it's a mandibular resection prosthesis. So it all pertains to the surgery and the reconstruction that Dr. Morlandt or Dr. Ying do that help rehabilitate the patient. So there is definitely a role for medical insurance in all of this and we usually find a really good way of getting it covered.

Melanie Cole (Host): As we work our way through this really important podcast, I'd like to give you all a chance for some final thoughts. And Christina, I would like to start with you. If you were to think of your patients, what do you find are the most important issues to patients and families as they navigate that cancer care and how you help them? And remember, this is for your referring physicians, so they are looking to the specialists at UAB Medicine. How are you helping them navigate this confusing and scary world of oral cancer?

Christina Cyriac: So here at UAB and specifically in our clinic, we help the patients navigate through their cancer journey throughout a multitude of ways. We have a clinical care coordinator, who helps patients as well as a patient portal. Patients are available to send us their questions and concerns and we get back to them just as quickly as we can. So our patients through their care here at UAB have access to our head and neck cancer support group, our supportive care department, which helps link up the patients with physical therapists, lymphedema therapists, speech-language pathologists. We help our patients with any of the other appointments and referrals they need. We're also available to answer any referring physician's questions in regards to if any staging CT scans need to be done prior to an appointment, we can help them arrange those as well.

Melanie Cole (Host): Dr. Kase, next to you, do you have a vision for this program? If you were to say about this care model and the way that it improves the way that patients receive their care, as you're speaking to other physicians that maybe want to simulate this type of care model, tell them what you would like them to know about how well it's working and how great you all work together.

Dr Michael Kase: Well, I think first of all, what makes it work so well is the people we have, like our team is I can't say enough good things about our team. Everybody on our team is outstanding and I'm privileged to work with them every single day, so, number one, that makes a huge difference in the character and integrity of the people you have as well as their skillset. But secondly, I would say the best advice in terms a vision for this program, is if you're wanting to emulate, it would be plan ahead because we're growing so fast. We need to make room for ourselves as we grow. And that's a good thing because then we have the ability to take care of all these patients, this influx of patients that we have. But, as we grow, we need physical space, we need more faculty, we need all of the supporting staff to help us too, so always plan for the ability to help more people.

Melanie Cole (Host): Dr. Morlandt, last question to you. As we wrap up, what would you like referring physicians to know about the special care that oral cancer patients are receiving at the UAB Oral Oncology Multidisciplinary Clinic and what you would like them to know about communication with the referring physicians, anything you'd like to wrap this up for us?

Dr Anthony Morlandt: Well, thank you. I really would like referring clinics, physicians, cancer centers to know that the reputation that UAB has enjoyed for many years hasn't changed. In fact, if anything, with our outstanding leadership and the great resources that have been put into the O'Neal Cancer Center, if anything, it's enhanced. We use the latest technology, state-of-the-art care. We have 3D imaging. We use surgical navigation in our small neck of the woods surgically. We use 3D printing to give a very patient-specific individualized outcome. And that's just the beginning.

So I just want anyone in the community who'd like to work with us and send us our patients, I'd like them to know that we appreciate your referrals. We appreciate the show of trust you've placed in us. And, for many years, we've been very fortunate to work with you and we'll continue to do so.

Melanie Cole (Host): Thank you all so much for joining us today, and such an informative podcast and such a great care model. Thank you again. And a physician can refer a patient to the UAB Medicine Oral Oncology Multidisciplinary Clinic by calling the mist line at 1-800-UAB-MIST or by visiting our website at uabmedicine.org/physician. That concludes this episode of UAB MedCast. Please remember to subscribe, rate and review this podcast and all the other UAB Medicine podcasts. I'm Melanie Cole. Thank you so much for joining us today.