Abstract
Aims: The study assessed the quality of diagnosis and staging offered to patients with a head and neck squamous cell carcinoma (HNSCC) and the variability across Belgian hospitals.Methods: In total, 9,245 patients diagnosed with HNSCC between 2009 and 2014, were identified in the population-based Belgian Cancer Registry (BCR). The BCR data were coupled with other databases providing information on diagnostic and therapeutic procedures reimbursed by the compulsory health insurance, vital status data, and comorbidities. The use of diagnosis and staging procedures was assessed by four quality indicators (QI) (i.e., use of dedicated head and neck imaging studies, use of PET-CT, TNM reporting and interval between diagnosis and start of treatment), for which a target was defined before the analysis. The association between the binary QIs and observed survival was assessed using Cox proportional hazard models adjusted for potential confounders.Results: Overall, 82.5% of patients received staging by MRI and/or CT of the head and neck region before the start of treatment. In 47.6% of stage III–IV patients eligible for treatment with curative intent, a whole-body FDG-PET(/CT) was performed. The proportion of patients whose cTNM and pTNM stage was reported to the BCR was 80.5 and 78.4%, respectively. The median interval from diagnosis to first treatment with curative intent was 32 days (IQR: 19–46). For none of these QIs the pre-set targets were reached and a substantial variability between centers was observed for all quality indicators. No binary QI was significantly associated with observed survival.Conclusions: The four quality indicators related to diagnosis and staging in HNSCC all showed substantial room for improvement. For none of them the pre-set targets were met at the national level and the variability between centers was substantial. Each Belgian hospital received an individual feedback report in order to stimulate reflection and quality improvement processes.
Highlights
In 2016, there were 2,694 new diagnoses of head and neck cancer in Belgium, 2,005 in males and 689 in females
The present study describes the quality of diagnosis and staging offered in Belgium to patients diagnosed with a squamous cell carcinoma of the head and neck (HNSCC) between 2009 and 2014
The Belgian Cancer Registry (BCR) database comprises the following patient and tumor characteristics: age at diagnosis, gender, WHO/ECOG (Eastern Cooperative Oncology Group) performance status score [from score 0 to score 4], clinical and pathological TNM stages [15, 16], and topography and histology of the tumor (ICD-O-3)
Summary
In 2016, there were 2,694 new diagnoses of head and neck cancer in Belgium, 2,005 in males and 689 in females. In Belgium, head and neck cancer is the 4th most frequent tumor in males (6% of all malignancies) and the 11th most frequent in females (2%) [2]. Compared to other European countries, Belgium has a very high incidence rate of head and neck cancer: Belgium ranks second for males (after France) and fourth for females (after Denmark, France and the Netherlands) [2]. The 5-year relative survival rate for the Belgian 2009–2013 cohort was about 51% in males and 58% in females [2]. By 2025, the annual number of patients diagnosed with head and neck cancer is expected to rise to more than 3,000 [3]
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