NFORC is The National Facial, Oral and Oculoplastic Research Centre funded by Saving Faces - The Facial Surgery Research Foundation
NFORC is the UK’s Head and Neck Surgical Trials Unit which is dedicated to developing, running and coordinating prospective cohort and randomised studies on a wide range of clinical topics relevant to the Head and Neck anatomical domain.
NFORC has resulted from a collaboration between the British Association of Oral and Maxillofacial Surgeons (BAOMS), Saving Faces – The Facial Surgery Research Foundation (SF-FSRF), the Cancer Research UK Prevention Trials Unit (CPTU), The Barts Clinical Trials Unit (BCTU) and NHS Digital.
The intellectual leadership for NFORC trials emanates from the BAOMS Research and Clinical Effectiveness Committees.
NFORC is very experienced in all stages of planning, conducting and disseminating clinical trials within NHS settings.
Please contact the team or call 020 8223 8049 and they will be only too happy to advise on your project.
- NFORC Launch – NFORC was officially launched in November 2014. The Launch event was attended by health care professionals across the spectrum of head and neck clinical care including an address from NHS England’s Medical Director, Sir Bruce Keogh. Along with a number of other leading surgeons and dentists, world-famous actor and Saving Faces Patron, Alan Rickman officially opened the centre along with award-winning journalist, Jon Snow.
- NFORC has hosted a variety of open and closed research summits since its launch. The Skin Research Summit, held in January 2015, in particular generated a number positive leads for collaborative research projects including developing a skin carcinoma database in collaboration with the Royal College of Surgeons.
- NFORC has sought to create strong links with BAOMS and OMFS trainees. These trainees are (or will shortly be) on the front line of clinical care, and their links with NFORC will equip them with a ‘research mind’ and ensure trainees are perfectly placed to identify current gaps in our knowledge and plan future studies.
- In May 2016, Saving Faces researchers presented current projects to a group of surgical trainees at the Dental School at The Royal London Hospital. The trainees found all the projects very exciting, asked lots of questions and even offered to help screen patients!
- In December 2016, NFORC hosted a free maxillofacial and Head & Neck trainee collaborative research summit. This included ‘train the trainer’ sessions, an introduction to Saving Faces’ flagship project, the National Head and Neck Audit (HANA) and a ‘Dragons Den’ panel discussing proposals for new studies submitted by trainees.
- NFORC currently has a wide portfolio of ongoing clinical research trials focussed on topics in oral and maxillofacial surgery, head and neck oncology as well as associated specialties. See below for a selection of current projects:
- The SEND study: SEND is a prospective, randomised clinical trial comparing two surgical treatments for early mouth cancer; elective vs. therapeutic neck dissection in terms of overall 5-year survival.
- For mouth cancer, the first point of malignancy is usually to the lymph nodes. However, research shows that 20-30% of patients with early mouth cancer exhibit secondaries in the neck glands that are too small to be detected clinically.
- There is currently no universally accepted evidence to show whether all patients should have a prophylactic neck operation or whether it is just as good to operate at a later date if and when secondaries develop. This is why NFORC, in collaboration with Cancer Research UK are running the SEND trial.
- TMJ: Temporomandibular Joint Dysfunction (TMD) affects 25% of the population. However, as shown by our research, there is a large degree of clinical equipoise for the effectiveness of widely-prescribed therapeutic interventions.
- Saving Faces recently sampled a representative group of over 200 OMFS surgeons, restorative dentists, oral medicine consultants and others and found a wide variety in clinical practice that is dependent on clinician specialty.
- From this survey, Saving Faces is currently developing an RCT comparing the treatments currently offered for TMD, to increase the evidence base for which interventions are effective, subsequently informing clinical guidelines.
- GRAD: One of the most serious complications of radiotherapy or chemoradiotherapy delivered to the head and neck region is muscle scarring and fibrous tissue resulting in dysphagia or trouble swallowing. Up to 83% of head and neck cancer patients experience some degree of dysphagia, which can have a debilitating effect on a wide-variety of patients’ functionality and quality of life.
- It has been reported that small genetic variations may be associated with propensity to develop these radiation-induced complications. GRAD is a Genome-Wide Association Study (GWAS) comparing the genomic profiles of head and neck cancer patients with and without severe dysphagia following radiotherapy.
- If genetic variations that can predict severe radiation complications in head and neck cancer patients are identified, this could provide the opportunity for future radiotherapy treatment plans to be tailored to the individual patients’ genetic profiles, ensuring each patient has the best care, personalised for them.
- Survivorship: There is surprisingly little published data on the effect of head and neck cancer on the quality of life of patients and their carers.
- Our Saving Faces PhD candidate Elisavet Moschopoulou is currently working on a retrospective questionnaire-based cohort study and have gathered information on clinical, functional and psychosocial measures from survivors of head and neck cancer.
- Elisavet’s project seeks to identify the factors that shape patients’ quality of life, as well as to better understand the long-term psychological effects of head and neck cancer on patients and on their caregiver. This information will provide a basis for developing online psychological interventions to support head and neck cancer patients and their families.
- HANA: After more than ten years, development and management of the National Head and Neck Audit has moved from the Health and Social Care Information Centre (HSCIC, now NHS Digital) to Saving Faces – The Facial Surgery Research Foundation.
- Under this new management team the audit has been renamed the Head and Neck Cancer Audit (HANA) and the underlying database software will be provided by Dendrite Clinical Systems.
- One of the key priorities of the HANA project is to assess the whole pathway for patients diagnosed with new primary or recurrent head and neck cancer in England and Wales, helping to improve the quality of clinical services and outcomes for patients.
- Saving Faces are working closely with the British Association of Head and Neck Oncologists (BAHNO) to ensure that HANA focuses on information that is really relevant to real-world patient outcomes.
- In this effort, Saving Faces has been working with other specialist organisations that work with head and neck cancer patients to develop the clinical reach of the audit. These include representatives from Restorative Dentistry, Dietetics, Speech and Language Therapy and Psychiatry, to name a few.
- NOA: The National Corrective Jaw Treatment Audit is a national clinical audit which collects information about patients undergoing corrective jaw surgery and uses it to measure the quality of patient care.
- The results will also be used to help surgeons understand more about the best treatment options to improve jaw and teeth relationships, their function and appearance. The fundamental aims of these audits is to improve patient care and whether patients are benefiting from their treatments.
- N3MA: The National Third Molar Audit (N3MA) is a national clinical audit collecting information about the treatment of wisdom teeth and associated problems to measure the quality of patient care.
- N3MA investigates:
- Morbidity associated with third molar pathology
- Referral patterns
- Whether patients are offered treatment in accordance with NICE guidelines
- Other patient benefits from treatment which may be overlooked
- Whether innovative treatments such as coronectomies are safe in the long-term
- Results will also be used to help surgeons and health care professionals understand more about the best treatments for third molar problems.
- BAOMS have commissioned NFORC to organise and lead the audit, working with local surgeons and NHS Digital who are providing IT infrastructure and the N3MA database.
- Please contact NFORC for more information on N3MA.
NFORC has recently initiated their own Trainee Collaborative by hosting the ‘Maxillofacial Head and Neck Trainee Collaborative Research Summit’ in December 2016. The aim of this collaborative is to provide support and guidance to trainees to develop their research ideas into multi-centre clinical trials. It also offers them an opportunity to work closely with research active Consultant Surgeons and gain valuable experience by working in a multi-disciplinary research team. Further information about current projects
The NFORC team consists of experienced Clinical Researchers, Project Managers and Trial Co-ordinators who provide both research and administrative support to develop a project into a fully funded clinical trial. It is also staffed by Statisticians, Epidemiologists, Methodologists, Psychologists, Health Economists and Sociologists, all of whom are dedicated to OMFS research.