Abstract
BackgroundTo assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients.MethodsRetrospective study using a U.S. healthcare research database (MarketScan). Index diagnoses were considered from 2010 to 2012 with follow-up from 2013 to 2014. Diagnostic and procedure codes were utilized to identify oral cavity patients with a defined treatment modality. Compliance with guideline-recommended processes of care, which included pre-treatment imaging, thyroid-function testing (TFTs), multidisciplinary consultation and gastrostomy-tube insertion rates, were assessed.ResultsA total of 2752 patients were identified. Surgery alone was the most common treatment (60.8%), followed by surgery with adjuvant chemoradiotherapy (20.4%) and surgery with adjuvant radiotherapy (18.8%). Head/neck and chest imaging were obtained in 60% and 62.5% of patients respectively. Significant geographical differences in head and neck imaging were observed between North-central (64%), South (58.4%) and West (56.1%) regions (p = 0.026). Differences in chest imaging were also present between North-east (65%) and West (56.8%; p = 0.007). TFTs were obtained in 54.4% of the patients after radiation treatment, and 18.6% of patients had multidisciplinary consultation during the 6 months before and 3 months after initiation of treatment. During the year after treatment initiation, 21.2% of patients underwent G-tube placement, with significantly higher rates in patients receiving triple modality treatment (58%) when compared to surgery plus radiation (27%) and surgery alone (15%; p < 0.01).ConclusionAdherence to evidence-based practices was low based on the database coding. These data suggest a potential to improve adherence and increase the routine use of practices delineated in national clinical practice guidelines.Clinical relevanceThis study reflects a suboptimal adherence to guidelines based on the database employed. This study should be considered by healthcare providers and efforts should be maximized to follow the processes of care which have proven to impact on patient's outcomes.
Highlights
To assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients
This study should be considered by healthcare providers and efforts should be maximized to follow the processes of care which have proven to impact on patient’s outcomes
Guideline‐recommended processes The number of patients who underwent imaging of the head and neck (Computer Tomography -Computer tomography (CT)- scan, Magnetic Resonance Imaging -MRI- or, ultrasound) and chest (x-ray, CT scan or MRI) prior to the initiation of the first treatment modality was tabulated during the time period within 2 months of the oral cavity cancer diagnosis date
Summary
To assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients. The Donabedian model [2] provides the framework to evaluate QoC through three different categories: structure,processes of care,outcomes, Evidence-based guidelines, including those from the National Comprehensive Cancer Network (NCCN), National Institute for Health and Care Excellence (NICE) and Cancer Care Ontario (CCO) [3,4,5], have been developed worldwide for the management of head and neck cancer, highlighting processes of care and designating quality indicators. Practices such as pre-treatment imaging, multidisciplinary consultation, and follow-up recommendations are endorsed. Analyzing adherence of physicians to these processes of care, may be a surrogate for QoC, and can provide insight into gaps in the quality of delivered care
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