Z G Schwam1, J A Sosa2, S Roman3, B L Judson4. 1. Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, USA. Electronic address: zachary.schwam@yale.edu. 2. Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA. 3. Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA. 4. Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, USA.
Abstract
AIMS: It is unknown whether receiving treatment that is discordant with practice guidelines is associated with improved survival in patients with nasopharyngeal carcinoma. The objectives of this study were to characterise national treatment patterns, analyse whether treatment outside of practice guidelines is associated with overall survival, and identify variables associated with receiving guidelines-discordant care in the USA. MATERIALS AND METHODS: This was a retrospective cohort study of 1741 nasopharyngeal carcinoma patients in the National Cancer Data Base (2003-2006). Treatment regimens were compared with the 2004-2006 National Comprehensive Cancer Network guidelines. Statistical analyses included chi-square, Kaplan-Meier, multivariable logistic, and Cox regression. RESULTS: Nearly 26% of our cohort received care discordant with practice guidelines. In multivariable analysis, patients with stage IVC disease (odds ratio 2.59, 95% confidence interval 1.66-4.04) were more likely to receive guidelines-discordant care when compared with those with stage II-IVB disease. The most common treatment deviation for those with stage I disease was overtreatment with chemoradiation therapy. Receiving guidelines-discordant care was associated with an increased risk of death (hazard ratio 1.46, 95% confidence interval 1.25-1.69). CONCLUSIONS: Many patients with stages I and IVC nasopharyngeal carcinoma do not receive care in accordance with practice guidelines. Receiving guidelines-discordant care is associated with compromised overall survival in the USA.
AIMS: It is unknown whether receiving treatment that is discordant with practice guidelines is associated with improved survival in patients with nasopharyngeal carcinoma. The objectives of this study were to characterise national treatment patterns, analyse whether treatment outside of practice guidelines is associated with overall survival, and identify variables associated with receiving guidelines-discordant care in the USA. MATERIALS AND METHODS: This was a retrospective cohort study of 1741 nasopharyngeal carcinomapatients in the National Cancer Data Base (2003-2006). Treatment regimens were compared with the 2004-2006 National Comprehensive Cancer Network guidelines. Statistical analyses included chi-square, Kaplan-Meier, multivariable logistic, and Cox regression. RESULTS: Nearly 26% of our cohort received care discordant with practice guidelines. In multivariable analysis, patients with stage IVC disease (odds ratio 2.59, 95% confidence interval 1.66-4.04) were more likely to receive guidelines-discordant care when compared with those with stage II-IVB disease. The most common treatment deviation for those with stage I disease was overtreatment with chemoradiation therapy. Receiving guidelines-discordant care was associated with an increased risk of death (hazard ratio 1.46, 95% confidence interval 1.25-1.69). CONCLUSIONS: Many patients with stages I and IVC nasopharyngeal carcinoma do not receive care in accordance with practice guidelines. Receiving guidelines-discordant care is associated with compromised overall survival in the USA.
Authors: Andrea N Burnett-Hartman; Natalia Udaltsova; Lawrence H Kushi; Christine Neslund-Dudas; Alanna Kulchak Rahm; Pamala A Pawloski; Douglas A Corley; Sarah Knerr; Heather Spencer Feigelson; Jessica Ezzell Hunter; David C Tabano; Mara M Epstein; Stacey A Honda; Monica Ter-Minassian; Julie A Lynch; Christine Y Lu Journal: JCO Clin Cancer Inform Date: 2019-09
Authors: Leila T Tchelebi; Biyi Shen; Ming Wang; Louis Potters; Joseph Herman; Daniel Boffa; Joel E Segel; Henry S Park; Nicholas G Zaorsky Journal: Adv Radiat Oncol Date: 2022-03-08