Adherence to guideline‐recommended process measures for squamous cell carcinoma of the head and neck in Ontario: Impact of surgeon and hospital volume

Eskander, Antoine; Monteiro, Eric; Irish, Jonathan C.; Gullane, Patrick; Gilbert, Ralph W.; Almeida, John de; Brown, Dale; Freeman, Jeremy L.; Urbach, David R.; Goldstein, David P.

doi:10.1002/hed.24364

Cited by 32 publications

(43 citation statements)

References 23 publications

(32 reference statements)

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“…A recently published study using population-based data in Ontario demonstrates similar results with less than perfect compliance with key guideline recommended processes of care: pre-operative imaging (82.5 %), pre-operative head and neck imaging (71.8 %), pre-operative multidisciplinary care (57.6 %), and post-operative follow up visits (76.7 %) [26]. Nearly all of these measures were higher among higher volume surgeons and hospitals.…”

Section: Beyond the Volume-outcome Relationshipsupporting

confidence: 74%

Health Services Research and Regionalization of Care—From Policy to Practice: the Ontario Experience in Head and Neck Cancer

2016

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Patients being treated at higher case volume hospitals or by higher case volume physicians appear to have better outcomes. This volume-outcome relationship is reviewed for oncologic and non-oncologic surgery with a focus on head and neck oncology. The impact of these research findings on health policy and health-care organization in Ontario, Canada, is then outlined. Lastly, future directions for quality improvement in surgical oncology are reviewed in the context of a universal health-care system. These include surgeon report cards, pre-operative checklists, linking funding and remuneration to the quality of delivered care, and the use of process improvement techniques.

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Section: Beyond the Volume-outcome Relationshipsupporting

confidence: 74%

Health Services Research and Regionalization of Care—From Policy to Practice: the Ontario Experience in Head and Neck Cancer

2016

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“…In this study, a 50% relative decrease in overall survival was found for patients who initiate adjuvant therapy more than 6 weeks after surgery, a 15% relative increased risk of death persisted on multivariable analysis adjusting for numerous confounding factors, and a 20% relative increased risk of death in the propensity-matched subset analysis. These findings led further support to the idea that, at least with regards to the timing of adjuvant therapy, guideline-adherent head and neck oncology care is quality care 39–41 .…”

Section: Discussionmentioning

confidence: 70%

Effect of time to initiation of postoperative radiation therapy on survival in surgically managed head and neck cancer

Graboyes

Garrett‐Mayer

Ellis

et al. 2017

Cancer

123

167

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Background Determine the effect of National Comprehensive Cancer Network Guideline- adherent initiation of postoperative radiation therapy (PORT), and different time to PORT intervals, on overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC). Methods Reviewing the National Cancer Database (NCDB) from 2006–2014, patients with HNSCC undergoing surgery and PORT were identified. Kaplan-Meier survival estimates, Cox regression analysis, and propensity score matching were used to determine the effect of initiating PORT ≤ 6 weeks of surgery, and different time to PORT intervals, on survival. Results 41,291 patients were included in the study. After adjusting for covariates, starting PORT > 6 weeks postoperatively was associated with decreased OS (adjusted Hazard Ratio [aHR] 1.13; 99% confidence interval [CI] 1.08–1.19). This finding remained in the propensity score-matched subset (HR 1.21; 99% CI 1.15–1.28). Relative to starting PORT 5 to ≤ 6 weeks postoperatively, initiating PORT earlier was not associated with improved survival (≤ 4 weeks: aHR 0.93; 99% CI 0.85–1.02, 4 to ≤ 5 weeks: aHR 0.92; 99% CI 0.84–1.01). Increasing duration of delays beyond 7 weeks were associated with progressive small survival decrements (aHR 1.09, 1.10, and 1.12 for 7 to ≤ 8 weeks, 8 to ≤ 10 weeks, and > 10 weeks). Conclusions Non-adherence to NCCN Guidelines for initiating PORT within 6 weeks of surgery is associated with decreased survival. There is no survival benefit to initiating PORT earlier within the recommended 6-week timeframe. Increasing durations of delays beyond 7 weeks are associated with small progressive survival decrements.

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“…Discrepancies between guideline-directed care and delivered care have been described across the spectrum of pretreatment evaluation, treatment, and posttreatment surveillance for patients with oral cavity cancer 13 and laryngeal cancer 14,15 and in the receipt of adjuvant therapy for patients who have head and neck cancer with high-risk features. 18 Continued effort will be required to improve the quality of care delivered to these patients. 18 Continued effort will be required to improve the quality of care delivered to these patients.…”

Section: Frequency Of Care That Does Not Adhere To Nccn Guidelinesmentioning

confidence: 99%

Adherence to National Comprehensive Cancer Network guidelines for time to initiation of postoperative radiation therapy for patients with head and neck cancer

Graboyes

Garrett‐Mayer

Sharma

et al. 2017

Cancer

103

236

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Over 50% of patients with HNSCC who undergo surgery and PORT receive care that does not adhere to National Comprehensive Cancer Network guidelines with regard to initiating PORT within 6 weeks of surgery. Sociodemographic, oncologic, treatment, and hospital factors are all associated with failure to receive guideline-directed care and should be explored in future studies. Cancer 2017;123:2651-60. © 2017 American Cancer Society.

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Adherence to guideline‐recommended process measures for squamous cell carcinoma of the head and neck in Ontario: Impact of surgeon and hospital volume

Cited by 32 publications

References 23 publications

Health Services Research and Regionalization of Care—From Policy to Practice: the Ontario Experience in Head and Neck Cancer

Health Services Research and Regionalization of Care—From Policy to Practice: the Ontario Experience in Head and Neck Cancer

Effect of time to initiation of postoperative radiation therapy on survival in surgically managed head and neck cancer

Adherence to National Comprehensive Cancer Network guidelines for time to initiation of postoperative radiation therapy for patients with head and neck cancer

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