Antoine Eskander1, Axel Sahovaler2, Jennifer Shin3, Konrado Deutsch2, Matthew Crowson2, Neerav Goyal4, David L Witsell5, Kristine Schulz5, Neil D Gross6, Randal Weber6, Samir S Khariwala7, Seth Cohen5, Derek Walter CyrLee5,8, Vikas Mehta9. 1. Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, University of Toronto, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada. antoine.eskander@mail.utoronto.ca. 2. Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, University of Toronto, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada. 3. Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. 4. Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. 5. Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA. 6. Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, USA. 7. Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA. 8. Clinical Research Unit, Duke University, Durham, NC, USA. 9. Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, NY, USA.
Abstract
BACKGROUND: To assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients. METHODS: Retrospective 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. RESULTS: A 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). CONCLUSION: Adherence 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 RELEVANCE: This 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.
BACKGROUND: To assess variations in adherence to guideline-recommended processes of care for oral cavity cancerpatients. METHODS: Retrospective 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. RESULTS: A 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). CONCLUSION: Adherence 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 RELEVANCE: This 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.
Entities:
Keywords:
Guideline-recommended processes of care; MarketScan; Oral cavity carcinoma
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