Summary of Japanese clinical practice guidelines for head and neck cancer - 2025 update edited by the Japan Society for Head and Neck Cancer.

Summary of Japanese clinical practice guidelines for head and neck cancer - 2022 update edited by the Japan society for head and neck cancer

This fourth edition of the Japanese Clinical Practice Guidelines for Prostate Cancer 2023 is compiled. It was revised under the leadership of the Japanese Urological Association, with members selected from multiple academic societies and related organizations (Japan Radiological Society, Japanese Society for Radiation Oncology, the Department of EBM and guidelines, Japan Council for Quality Health Care (Minds), Japanese Society of Pathology, and the patient group (NPO Prostate Cancer Patients Association)), in accordance with the Minds Manual for Guideline Development (2020 ver. 3.0). The most important feature of this revision is the adoption of systematic reviews (SRs) in determining recommendations for 14 clinical questions (CQs). Qualitative SRs for these questions were conducted, and the final recommendations were made based on the results through the votes of 24 members of the guideline development group. Five algorithms based on these results were also created. Contents not covered by the SRs, which are considered textbook material, have been described in the general statement. In the general statement, a literature search for 14 areas was conducted; then, based on the general statement and CQs of the Japanese Clinical Practice Guidelines for Prostate Cancer 2016, the findings revealed after the 2016 guidelines were mainly described. This article provides an overview of these guidelines.

Japanese clinical practice guidelines for oral cancer, 2023.

To further improve the quality of head and neck cancer (HNC) care, we developed a composite measure defined as "textbook outcome" (TO). We analyzed a retrospective cohort of patients after curvative-intent primary surgery, radiotherapy (RT), or chemoradiation (CRT) for HNC between 2015 and 2018 at the Netherlands Cancer Institute. TO was defined as 1) the start of treatment within 30 days, 2a) satisfactory pathologic outcomes, without 30-day postoperative complications, for the surgically treated group, and 2b), for RT and CRT patients, no unexpected or prolonged hospitalization and toxicity after the completion of treatment as planned. In total, 392 patients with HNC were included. An overall TO was achieved in 9.6% of patients after surgery, 20.6% after RT, and 2.2% after CRT. Two indicators (margins >5 mm and start treatment <30 days) reduced TO radically for both groups. TO can aid the evaluation of the quality of care for HNC patients and guide improvement processes. 3 Laryngoscope, 132:78-87, 2022.

Clinical Practice Guidelines for Pancreatic Cancer based on Evidence-Based Medicine 2006 were first published by the Japan Pancreas Society, and they were revised to Clinical Practice Guidelines for Pancreatic Cancer 2009 in July 2009 and were further revised to Clinical Practice Guidelines for Pancreatic Cancer 2013 in October 2013. These guidelines were established according to evidence-based medicine. In October 2016, the Clinical Practice Guidelines for Pancreatic Cancer were newly revised in Japanese. In the revised version, we introduced the concepts of GRADE - grading recommendations assessment, development, and evaluation approach for better understanding of the current guidelines. The guidelines show algorithms for the diagnosis, treatment, and chemotherapy of pancreatic cancer and address 7 subjects: diagnosis, surgical therapy, adjuvant therapy, radiation therapy, chemotherapy, stent therapy, and palliative medicine. They include 51 clinical questions and 76 statements. There are statements corresponding to clinical questions, evidence levels, recommended strengths, and agreement rates. These guidelines represent the most standard clinical and practical management at this time in Japan. This is the English synopsis of the Clinical Practice Guidelines for Pancreatic Cancer 2016 in Japanese, which aims to disseminate the Japanese guidelines worldwide for the introduction of Japanese clinical management of these diseases.

Japanese Clinical Practice Guideline for Head and Neck Cancer

BackgroundPatients with head and neck cancers (HNC) experience many transitions in care (TiC), occurring when patients are transferred between healthcare providers and/or settings. TiC can compromise patient safety, decrease patient satisfaction, and increase healthcare costs. The evidence around TiC among patients with HNC is sparse. The objective of this study was to improve our understanding of TiC among patients with HNC to identify ways to improve care.MethodsThis multimethod study consisted of two phases: Phase I (retrospective population-based cohort study) characterized the number and type of TiC that patients with HNC experienced using deterministically linked, population-based administrative health data in Alberta, Canada (January 1, 2012, to September 1, 2020), and Phase II (qualitative descriptive study) used semi-structured interviews to explore the lived experiences of patients with HNC and their healthcare providers during TiC.ResultsThere were 3,752 patients with HNC; most were male (70.8%) with a mean age at diagnosis of 63.3 years (SD 13.1). Patients underwent an average of 1.6 (SD 0.7) treatments, commonly transitioning from surgery to radiotherapy (21.2%). Many patients with HNC were admitted to the hospital during the study period, averaging 3.3 (SD 3.0) hospital admissions and 7.8 (SD 12.6) emergency department visits per patient over the study period. Visits to healthcare providers were also frequent, with the highest number of physician visits being to general practitioners (average = 70.51 per patient). Analysis of sixteen semi-structured interviews (ten patients with HNC and six healthcare providers) revealed three themes: (1) Navigating the healthcare system including challenges with the complexity of HNC care amongst healthcare system pressures, (2) Relational head and neck cancer care which encompasses patient expectations and relationships, and (3) System and individual impact of transitions in care.ConclusionsThis study identified challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within cancer care, which was perceived to have an impact on quality of care. These findings provide crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of TiC within this patient population.

Identify patient-perceived barriers to head and neck cancer care and compare differences in barriers by country income status. Of the 37 articles, 51% ( n = 19) were from low- and middle-income countries (LMICs), while 49% ( n = 18) were from high-income countries. Of the papers from high-income countries, unspecified head and neck cancer (HNC) subtype (67%, n = 12) were the most common cancer type, while upper aerodigestive tract mucosal malignancies (58%, n = 11) were more common in LMICs ( P = 0.02). Based on World Health Organization barriers, level of education ( P = < 0.01) and alternative medicine use ( P = 0.04) were greater barriers in LMICs compared to high-income countries. At least 50% of articles listed barriers at all three 'Three Delays' timepoints. There were no significant differences by country income status for the 'Three Delays' timepoints of deciding to seek care ( P = 0.23), reaching the healthcare facility ( P = 0.75), or receiving care ( P = 1.00). Patients face barriers to care for head and neck cancer regardless of country income status. There is overlap in several barriers and a need for systemic improvement in access. The differences in education and alternative medicine may guide region-specific interventions to improve the provision of head and neck services.

173 Background: Oncologic care is very complex, and delivery of integrated care with optimal alignment and collaboration of several disciplines is crucial. To monitor and effectively improve high-quality integrated oncologic care, a dashboard of valid and reliable quality indicators (QIs) is indispensable. A set of QIs is developed specifically for head and neck cancer (HNC) patients from three perspectives: patients (development of indicators from patient perspective, including the first results, are described in the abstract "PROMs and PREMs in Dutch integrated head and neck cancer care: Measurements and evaluation"), medical specialist and allied health professionals. This presentation concerns the first results from medical and allied health professional perspective. Methods: QIs on process, structure and outcome of care, were developed using an evidence based method: the Rand modified Delphi method. Data was collected in nine Dutch hospitals nearly 1,500 patients (November 2014 - December 2016). Indicators were calculated on national and hospital level and corrected for case-mix using SPSS. Results: The final set contained 5 outcome indicators from both perspectives, 13 and 18 process indicators from the perspective of medical specialists and allied health professionals respectively, and three structure indicators from the perspective of allied health professionals. Besides, 10 case-mix factors were selected. Current practice assessment, in 1263 patients, produced high scores on integrated care indicators, e.g., the percentage of patients discussed in multidisciplinary team meeting before start of the treatment (93%) and availability of a treatment plan (99%). However, involvement of dental teams (range 57 – 100%) and malnutrition screening (range 8-35%) could be improved in most hospitals. In addition, most hospitals did not meet the standard of 80% on patients starting with treatment within 30 days. Conclusions: The quality of integrated multidisciplinary care for patients with head and neck cancer in the Netherlands is already high on some aspects, but varied between hospitals and shows room for improvement. This study can be an example for other oncologic diseases where integrated care is necessary.

The Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer, 2022 Edition was published in June 2022. The guidelines were prepared while conforming as much as possible to the “Minds Manual for Guideline Development 2020 ver. 3.0.” edited by the Minds Manual Development Committee of the Japan Council for Quality Health Care in 2021. In addition, a survey of Japanese Breast Cancer Society members on the 2018 edition of the guidelines was conducted from February 19 to March 4, 2021. Based on the responses from over 600 members, original innovations were made to make the guidelines more user-friendly. The 2018 edition of the guidelines was developed to provide support tools for physicians and patients to utilize shared decision-making. The 2022 guidelines consist of two volumes: (1) an “Epidemiology and Diagnosis” section covering “Screening and Diagnosis”, “Radiological diagnosis”, and “Pathological diagnosis”, and (2) a “Treatment” section covering “Surgical therapy”, “Radiation therapy”, and “Systemic therapy”. We believe that this concise summary of the guidelines will be useful to physicians and researchers in Japan and overseas.

ObjectivesClinical Practice Guidelines for Pancreatic Cancer was first published in 2006 by the Japan Pancreas Society, and revised in 2009, 2013, 2016, and 2019. In July 2022, Clinical Practice Guidelines for Pancreatic Cancer was newly revised in Japanese.MethodsFor this revision, we developed an entirely new guideline according to the Minds Manual for Guideline Development 2020, which includes the concepts of GRADE—Grading Recommendations Assessment, Development, and Evaluation, to enable a better understanding of the current guidelines. Patients and the public were actively involved in both the development and implementation of the guideline.ResultsThe guideline includes algorithms for diagnosis, treatment, chemotherapy, and precision medicine of pancreatic cancer, and addresses 7 subjects: diagnosis, surgical therapy, adjuvant therapy, radiation therapy, chemotherapy, stent therapy, and supportive & palliative medical care. It includes 73 clinical questions and 112 statements. The statements correspond to the clinical questions, evidence levels, recommendation strengths, and agreement rates.ConclusionsThis guideline represents the most standard clinical and practical management guideline available until date in Japan. This is the English synopsis of the Clinical Practice Guidelines for Pancreatic Cancer 2022 in Japanese, and is an attempt to disseminate the Japanese guideline worldwide to introduce the Japanese approach to the clinical management of pancreatic cancer.

e18023 Background: Patients with head and neck cancer (HNC) face a heightened risk of suicide, surpassing rates in other cancers and the general population. Unfortunately, there are currently no suicide-specific clinical guidelines in oncology, and it is unclear what barriers and facilitators impact suicide screening initiatives in HNC care. This qualitative study explored experiences, barriers and facilitators of suicide screening and management of mental health concerns in a diverse group of HNC clinicians. Methods: We conducted qualitative interviews with 16 HNC clinicians at a single healthcare system, including head and neck surgeons, radiation oncologists, medical oncologists, and nurses/nurse practitioners/physician assistants. Interviews covered topics such as clinicians’ perspective of the impact of HNC on patients’ mental health, experience with suicide risk assessment, existing protocols, and overall experiences related to managing mental health concerns in patients with HNC. Using rapid analysis techniques, we identified common challenges, facilitators, and training needs. Results: Our study uncovered distinct barriers faced by HNC clinicians. Key themes included the notable absence of formal suicide and mental health training among HNC clinicians; critical gaps in clinician education and the lack of established protocols for appraising and managing mental health concerns, particularly those related to suicide risk. Other barriers identified included clinicians’ uncertainties in recognizing and addressing suicidal thoughts, limited familiarity with available screening tools, and insufficient resources for patient support. Some key facilitators also emerged, including longer clinic visit times, mental health discussions in interdisciplinary conferences, and greater accessibility of mental health services for comprehensive patient support. Conclusions: In this qualitative study, we observed important barriers in mental health support and service delivery for HNC patients, especially gaps in clinician training, and lack of knowledge of existing suicide-related protocols. Given the suicide burden in HNC, it is important to address these challenges and begin developing initiatives for clinician training and formalized protocols to enhance mental health care for HNC patients.

Timely diagnosis and treatment are of paramount importance for patients with head and neck cancer (HNC) because delays are associated with reduced survival rates and increased recurrence risk. Prompt referral to HNC specialists is crucial for the timeliness of care, yet the factors that affect the referral and triage pathway remain relatively unexplored. Therefore, to identify barriers and facilitators of timely care, it is important to understand the complex journey that patients undertake from the onset of HNC symptoms to referral for diagnosis and treatment. To investigate the referral and triage process for patients with HNC and identify barriers to and facilitators of care from the perspectives of patients and health care workers. This was a qualitative study using semistructured interviews of patients with HNC and health care workers who care for them. Participants were recruited from June 2022 to July 2023 from HNC clinics at 2 tertiary care academic medical centers in Boston, Massachusetts. Data were analyzed from July 2022 to December 2023. Themes identified from the perspectives of both patients and health care workers on factors that hinder or facilitate the HNC referral and triage process. In total, 72 participants were interviewed including 42 patients with HNC (median [range] age, 60.5 [19.0-81.0] years; 27 [64%] females) and 30 health care workers (median [range] age, 38.5 [20.0-68.0] years; 23 [77%] females). Using thematic analysis, 4 major themes were identified: the HNC referral and triage pathway is fragmented; primary and dental care are critical for timely referrals; efficient interclinician coordination expedites care; and consistent patient-practitioner engagement alleviates patient fear. These findings describe the complex HNC referral and triage pathway, emphasizing the critical role of initial symptom recognition, primary and dental care, patient information flow, and interclinician and patient-practitioner communication, all of which facilitate prompt HNC referrals.

The care of patients with head and neck cancer is labor and cost intensive. Although several studies have focused on clinical outcomes with regionalization of care of such patients, it remains uncertain if and where such concentrations of care are occurring. A better understanding of how care is distributed will improve our understanding of the financial and educational impact of compacting treatment of these patients. To determine if regionalization of head and neck cancer care has occurred over the past decade with respect to hospital size and teaching hospital status. Secondary analysis of national health care database. All inpatient admissions with a primary head and neck cancer diagnosis contained within the Nationwide Inpatient Sample during the calendar years 2000, 2005, and 2010. The percentage distributions of head and neck cancer cases with respect to hospital teaching status, hospital bed size, and primary payer were compared according to calendar year to determine temporal changes. Multivariate analysis was conducted to determine year-to-year changes in proportion of head neck cancer admissions, controlling for geographic region, hospital bed size, and expected source of payment. The estimated inpatient hospital head and neck cancer stays in the United States in 2000, 2005, and 2010 (with standard error of the national estimate) were 28,862 (2067), 33,517 (3080), and 37,354 (4194), respectively. The percentage of admissions to teaching hospitals increased from 61.7% to 64.2% and 79.8%, respectively. Similarly, the percentage (with standard error) of cases in large-bed-size hospitals increased from 69.2% (2.8%) to 71.4% (3.8%) and 73.3% (4.8%), respectively. The primary expected payer distribution did not change significantly over the study (Medicare, 39.6% [1.4%]; Medicaid, 17.4% [2.2%]; private insurance, 33.3% [2.4%]; and other, 9.7% [1.5%] in 2010). The adjusted odds ratio for head neck cancer case being admitted to a teaching institution for 2010 vs 2000 was 2.5 (95% CI, 1.6-3.7). Head and neck oncologic care is increasingly being regionalized to teaching hospitals and academic centers. Such regionalization also has important implications for future education of residents and measures of achieved competency.

232 Background: As specialty- and disease-specific treatment recommendations based on the best available evidence and/or expert consensus, clinical practice guidelines such as those set forth by the National Comprehensive Care Network (NCCN) establish the current standard of quality care; adherence to these guidelines can serve as a measure of the quality and effectiveness of care. We aimed to assess multidisciplinary conference (MC) treatment recommendations’ adherence to NCCN head and neck cancer guidelines, while identifying potential areas for quality improvement. Methods: Patients presented with previously untreated head and neck cancers are being prospectively accrued as they are presented at weekly MC. The charts of patients presented between 10/20/2011 and 10/20/2013 were reviewed for clinical data leading up to MC to allow us to assess whether, based on the available information, the recommendations of conference are compliant with NCCN treatment guidelines. Results: Of 556 enrolled patients, 49.1% had oropharyngeal cancer, 28.2% had oral cavity cancer, 19.3% had laryngeal cancer, and 3.4% had nasopharyngeal cancer. For the entire cohort, the mean age at presentation was 58.9 years (16.4 - 89.3). Four hundred forty three patients (79.7%) were men. The recommendations of conference were non-compliant with NCCN treatment guidelines for 6.2% patients (17/273) with oropharyngeal cancer, 13.4% patients with oral cavity cancer (21/157), 0.9% patients (1/107) with laryngeal cancer, and 15.8% patients (3/19) with nasopharyngeal cancer. The most common reasons for non-compliance were recommended treatment of N2 oropharyngeal disease with definitive radiation alone (13 patients) and recommended over-use of induction chemotherapy (14 patients). Conclusions: NCCN guideline compliance can be used to evaluate the quality of head and neck cancer care. We have identified areas for potential improvement within our institution. Further study is needed to evaluate how care that deviates from NCCN guidelines affects patient outcomes.