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de Kort WWB, de Ruiter EJ, Haakma WE, Driehuis E, Devriese LA, van Es RJJ, Willems SM. p-mTOR, p-ERK and PTEN Expression in Tumor Biopsies and Organoids as Predictive Biomarkers for Patients with HPV Negative Head and Neck Cancer. Head Neck Pathol 2023; 17:697-707. [PMID: 37486536 PMCID: PMC10514008 DOI: 10.1007/s12105-023-01576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Survival rates of head and neck squamous cell carcinoma (HNSCC) have only marginally improved in the last decades. Hence there is a need for predictive biomarkers for long-time survival that can help to guide treatment decisions and might lead to the development of new therapies. The phosphatidylinositol 3-kinase (PI3K)/AKT/mTOR signaling pathway is the most frequently altered pathway in HNSCC, genes are often mutated, amplificated and overexpressed causing aberrant signaling affecting cell growth and differentiation. Numerous genetic alterations of upstream and downstream factors have currently been clarified. However, their predictive value has yet to be established. Therefore we assess the predictive value of p-mTOR, p-ERK and PTEN expression. METHODS Tissue microarrays (TMA's) of HPV-negative patients with oropharyngeal (n = 48), hypopharyngeal (n = 16) or laryngeal (n = 13) SCC, treated with primary chemoradiation (cisplatin/carboplatin/cetuximab and radiotherapy), were histologically stained for p-mTOR, PTEN and p-ERK. Expression was correlated to overall survival (OS), disease free survival (DFS) and locoregional control (LRC). Also p-mTOR was histologically stained in a separate cohort of HNSCC organoids (n = 8) and correlated to mTOR-inhibitor everolimus response. RESULTS High p-mTOR expression correlated significantly with worse OS in multivariate analysis in the whole patient cohort [Hazar Ratio (HR) 1.06, 95%CI 1.01-1.11, p = 0.03] and in the cisplatin/carboplatin group with both worse OS (HR 1.09, 95%CI 1.02-1.16, p = 0.02) and DFS (HR 1.06, 95%CI 1.00-1.12, p = 0,04). p-ERK expression correlated significantly with DFS in univariate analysis in the whole patient cohort (HR 1.03, 95%CI 1.00-1.05, p = 0.04) and cisplatin/carboplatin group (HR 1.03, 95%CI 1.00-1.07, p = 0.04). PTEN-expression did not correlate with OS/DFS/LRC. Better organoid response to everolimus correlated significantly to higher p-mTOR expression (Rs = - 0.731, p = 0.04). CONCLUSIONS High p-mTOR expression predicts and high p-ERK expression tends to predict worse treatment outcome in HPV negative HNSCC patients treated with chemoradiation, providing additional evidence that these markers are candidate prognostic biomarkers for survival in this patient population. Also this study shows that the use of HNSCC organoids for biomarker research has potential. The role of PTEN expression as prognostic biomarker remains unclear, as consistent evidence on its prognostic and predictive value is lacking.
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Affiliation(s)
- W. W. B. de Kort
- Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - E. J. de Ruiter
- Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - W. E. Haakma
- Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - E. Driehuis
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center Utrecht, 3584 CT Utrecht, The Netherlands
| | - L. A. Devriese
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R. J. J. van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Head and Neck Surgical Oncology, Utrecht Cancer Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - S. M. Willems
- Department of Pathology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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Kowalski LP. Eugene Nicholas Myers' Lecture on Head and Neck Cancer, 2020: The Surgeon as a Prognostic Factor in Head and Neck Cancer Patients Undergoing Surgery. Int Arch Otorhinolaryngol 2023; 27:e536-e546. [PMID: 37564472 PMCID: PMC10411134 DOI: 10.1055/s-0043-1761170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 08/12/2023] Open
Abstract
This paper is a transcript of the 29 th Eugene N. Myers, MD International Lecture on Head and Neck Cancer presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 2020. By the end of the 19 th century, the survival rate in treated patients was 10%. With the improvements in surgical techniques, currently, about two thirds of patients survive for > 5 years. Teamwork and progress in surgical reconstruction have led to advancements in ablative surgery; the associated adjuvant treatments have further improved the prognosis in the last 30 years. However, prospective trials are lacking; most of the accumulated knowledge is based on retrospective series and some real-world data analyses. Current knowledge on prognostic factors plays a central role in an efficient treatment decision-making process. Although the influence of most tumor- and patient-related prognostic factors in head and neck cancer cannot be changed by medical interventions, some environmental factors-including treatment, decision-making, and quality-can be modified. Ideally, treatment strategy decisions should be taken in dedicated multidisciplinary team meetings. However, evidence suggests that surgeons and hospital volume and specialization play major roles in patient survival after initial or salvage head and neck cancer treatment. The metrics of surgical quality assurance (surgical margins and nodal yield) in neck dissection have a significant impact on survival in head and neck cancer patients and can be influenced by the surgeon's expertise. Strategies proposed to improve surgical quality include continuous performance measurement, feedback, and dissemination of best practice measures.
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Affiliation(s)
- Luiz P. Kowalski
- Head and Neck Surgery Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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3
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Eskander A, Sahovaler A, Shin J, Deutsch K, Crowson M, Goyal N, Witsell DL, Schulz K, Gross ND, Weber R, Khariwala SS, Cohen S, CyrLee DW, Mehta V. A preliminary assessment of guideline adherence and clinical variation in oral cancer treatment: a MarketScan database study. BMC Oral Health 2021; 21:270. [PMID: 34001080 PMCID: PMC8130137 DOI: 10.1186/s12903-021-01616-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Antoine Eskander
- 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.
| | - Axel Sahovaler
- 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
| | - Jennifer Shin
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Konrado Deutsch
- 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
| | - Matthew Crowson
- 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
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - David L Witsell
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Kristine Schulz
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Neil D Gross
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Randal Weber
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Seth Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Derek Walter CyrLee
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA.,Clinical Research Unit, Duke University, Durham, NC, USA
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, NY, USA
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4
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Verleye L, De Gendt C, Leroy R, Stordeur S, Schillemans V, Savoye I, Silversmit G, Van Eycken L, Daisne JF, Nuyts S, Vermorken J, Grégoire V. Patterns and quality of care for head and neck cancer in Belgium: A population-based study. Eur J Cancer Care (Engl) 2021; 30:e13454. [PMID: 33890328 DOI: 10.1111/ecc.13454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/11/2020] [Accepted: 03/18/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We evaluated the quality of care for patients with squamous cell carcinoma (SCC) of the oral cavity, oropharynx, hypopharynx or larynx in Belgium. METHODS Data of the Belgian Cancer Registry were coupled with health insurance data and hospital discharge data. Quality of care and the association with hospital volume were evaluated based on six quality indicators. RESULTS Half of the patients were treated with primary radiotherapy, with or without systemic therapy (49.7%) and 38.1% with surgery, with or without (neo)adjuvant therapy. Single-modality treatment was provided to 78.1% of early-disease patients. Of the patients with cN0 disease, 56.4% underwent neck dissection. Postoperative radiotherapy was completed timely in 48.5% of patients. Concomitant chemotherapy was administered to 58.2% of patients <70 years with locally advanced disease. Imaging of the neck after radiotherapy was performed appropriately in 32.7% of patients. Variability between centres was considerable. No clear relationship between hospital volume and results of the individual QIs was observed. CONCLUSIONS Results show that for the measured QIs, targets are not met and variability between centres is considerable. Through individual feedback, centres are motivated to improve the quality of care for head and neck cancer patients in Belgium.
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Affiliation(s)
- Leen Verleye
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Roos Leroy
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - Sabine Stordeur
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Isabelle Savoye
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | | | - Jean-Francois Daisne
- CHU-UCL-Namur, Department of radiation oncology, Université Catholique de Louvain, Namur, Belgium.,Department of Radiotherapy-Oncology, KU Leuven, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Sandra Nuyts
- Department of Radiotherapy-Oncology, KU Leuven, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Jan Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Grégoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
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5
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Liu SW, Woody NM, Wei W, Appachi S, Contrera KJ, Tsai JC, Ghanem AI, Matia B, Joshi NP, Geiger JL, Ku JA, Burkey BB, Scharpf J, Prendes BL, Caudell JJ, Dunlap NE, Adelstein DJ, Porceddu S, Liu H, Siddiqui F, Lee NY, Koyfman S, Lamarre ED. Evaluating compliance with process-related quality metrics and survival in oral cavity squamous cell carcinoma: Multi-institutional oral cavity collaboration study. Head Neck 2020; 43:60-69. [PMID: 32918373 DOI: 10.1002/hed.26454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/01/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Process-related measures have been proposed as quality metrics in head and neck cancer care. A recent single-institution study identified four key metrics associated with increased survival. This study sought to validate the association of these quality metrics with survival in a multi-institutional cohort. METHODS Multicenter retrospective study of patients with oral cavity squamous cell (1/2005-1/2015). Baseline patient and disease characteristics and compliance with quality metrics was evaluated. Association between compliance with quality metrics with overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) was evaluated using Cox proportional hazards models. RESULTS Failure to comply with two or more of the quality metrics was associated with worse OS, DFS, and DSS. Adherence to all or all but one of the quality metrics was found to be associated with improved survival. CONCLUSIONS Process-related quality metrics are associated with increased survival in patients with oral cavity squamous cell carcinoma in a multi-institutional cohort.
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Affiliation(s)
- Sara W Liu
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Neil M Woody
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Wei
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Swathi Appachi
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jillian C Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmed I Ghanem
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
| | - Brian Matia
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nikhil P Joshi
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jamie A Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian B Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Sandro Porceddu
- Department of Radiation Oncology, Princess Alexandra Hospital/University of Queensland, Brisbane, QLD, Australia
| | - Howard Liu
- Department of Radiation Oncology, Princess Alexandra Hospital/University of Queensland, Brisbane, QLD, Australia
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shlomo Koyfman
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
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Simon C, Nicolai P, Paderno A, Dietz A. Best Practice in Surgical Treatment of Malignant Head and Neck Tumors. Front Oncol 2020; 10:140. [PMID: 32117778 PMCID: PMC7028740 DOI: 10.3389/fonc.2020.00140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 01/27/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose of review: Defining the best practice of surgical care for patients affected by malignant head and neck tumors is of great importance. In this review we aim to describe the evolution of “best practice” guidelines in the context of quality-of-care measures and discuss current evidence on “best practice” for the surgical treatment of cancers of the sino-nasal tract, skull base, aero-digestive tract, and the neck. Recent findings: Current evidence based on certain structure and outcome indicators, but mostly based on process indicators already helps defining the framework of “Best practice” for head and neck cancer surgery. However, many aspects of surgical treatment still require in-depth research. Summary: While a framework of “Best practice” strategies already exists for the conduction of the surgical treatment of head and neck cancers, many questions still require additional research in particular in case of rare histologies in the head and neck region.
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Affiliation(s)
- Christian Simon
- Service d'Oto-rhino-laryngologie - Chirurgie cervico-faciale, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Lausanne, Switzerland
| | - Piero Nicolai
- Department of Otolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Andreas Dietz
- Department of Otolaryngology, Head and Neck Surgery, University Leipzig, Leipzig, Germany
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Early tongue carcinomas (clinical stage I and II): echo-guided three-dimensional diode laser mini-invasive surgery with evaluation of histological prognostic parameters. A study of 85 cases with prolonged follow-up. Lasers Med Sci 2019; 35:751-758. [PMID: 31834561 DOI: 10.1007/s10103-019-02932-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022]
Abstract
The management of patients with early stage (cT1-T2) tongue squamous cell carcinoma without clinicoradiologic evidence of neck node metastasis (cN0) has been widely debated over the last 3 decades and still remains controversial. Nevertheless, the identification of patients with low-stage tumours at high-risk for occult cervical metastases is imperative before planning treatments of primary tumours, as well as that of prognostic markers which may possibly select those patients who may benefit of additional workup after surgery in view of the high metastatic potential of the primary tumour. The pre-surgical evaluation of tongue malignant primary tumour (for assessing lateral and deep margins) along with diode laser surgery (with accurate incision, bleeding-free and with reduced/absent post-surgical complications) may lead to a more conservative but equally decisive surgical treatment, also with a greater patient compliance. We studied 85 consecutive cases of cT1-T2 N0 tongue squamous cell carcinoma who had been managed by the following diagnostic/therapeutic protocol: pre-operative high definition ultrasound examination for the evaluation of size and depth, followed by three-dimensional surgical excision by diode laser (wavelength of 800 ± 10 nm, output power of 8 W in continuous wave, flexible optic fibre of 320 μm in contact mode) and detailed histological analyses of well-established prognostic parameters (tumour grade, thickness, depth, front of infiltration and surgical margins) with statistical analysis. No post-surgical photobiomodulation was performed. Overall, 58.82% of patients were stage I, 18% stage II, and the most frequent histotype was squamous cell carcinoma (97.64%). Large nests invasion pattern was observed in 64 cases, expansive pattern in 9, invasion in single cells in 12; front of invasion involved the muscle in 62 cases, vessels in 6, nerves in 15; peritumoural vascular invasion was assessed in 6 patients and perineural invasion in 15. Selective neck lymphadenectomy was performed in 9 cases, and clinically occult node metastases were detected in two cases. At follow-up, 78 patients (98.73%) were alive and free of disease, one patient experienced tumour-related death, while the remaining 6 died for non-disease-related causes. All the histological prognostic parameters were statistically significant (χ2 test; p = 0.05), thus leading to a prognostic weight classification with a three-tiered stratification. On the bases of these results, the authors maintain that the reported diagnostic/therapeutic protocol, including the pre-operative echo-guided three-dimensional evaluation, the following diode laser mini-invasive surgery for tumour excision and the histological examination along with the proposed three-tiered stratification of histological prognostic parameters may allow proper management of clinical stage I and II early tongue carcinomas.
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Nocon CC, Ajmani GS, Bhayani MK. Association of Facility Volume With Positive Margin Rate in the Surgical Treatment of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2019; 144:1090-1097. [PMID: 30347018 DOI: 10.1001/jamaoto.2018.2421] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance The achievement of complete tumor resection with tumor-free margins is one of the main principles of oncologic surgery for head and neck squamous cell carcinoma (HNSCC). The negative prognostic influence of a positive margin (PM) across all head and neck subsites has been well established. National guidelines recommend the use of adjuvant chemoradiation therapy (CRT) in the setting of PM. Objective To determine the incidence of PM in HNSCC across multiple subsites, as well as the factors associated with its occurrence. Design, Setting, and Participants This retrospective cohort study used the National Cancer Database to identify patients diagnosed with HNSCC between 2010 and 2014 and who underwent surgical resection (n = 28 840). Main Outcomes and Measures Predictors of PM rate and likelihood to receive adjuvant CRT. Results Among the 28 840 patients included in this study, 19 727 (68.4 %) were men, and the average age was 62.4 years (range, 40 to ≥90 years). In univariable analysis, a lower PM rate was associated with higher facility volume (26.3% for the lowest volume quartile, 16.5% for the middle 2 quartiles, and 10.8% for the highest volume quartile) and treatment at academic vs nonacademic facilities (14.0% vs 22.7%). In multivariate analysis, those treated at higher-volume facilities remained significantly less likely to have PM (adjusted odds ratio, 0.85; 95% CI, 0.83-0.88). The trend of decreasing PM rate with increasing facility volume was observed in both academic (aOR, 0.88 per 10-case volume increase [95% CI, 0.85-0.91]) and nonacademic (aOR, 0.73 per 10-case volume increase [95% CI, 0.68-0.80]) facilities. There was no association between facility volume and patient likelihood of receiving adjuvant CRT in the setting of PM (compared with CCPs: aOR, 0.98 per 10-case volume increase [95% CI, 0.84-1.14] for CCCPs; and aOR, 1.24 [95% CI, 0.99-1.55] for INCPs). Conclusions and Relevance These findings suggest that high-volume facilities are associated with lower rates of PM in the surgical treatment of HNSCC in both academic and nonacademic settings. Facility volume for head and neck oncologic surgeries may be considered a benchmark for quality of care.
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Affiliation(s)
- Cheryl C Nocon
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Gaurav S Ajmani
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | - Mihir K Bhayani
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
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9
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Quality assurance in head and neck cancer surgery: where are we, and where are we going? Curr Opin Otolaryngol Head Neck Surg 2019; 27:151-156. [PMID: 30664051 DOI: 10.1097/moo.0000000000000519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW The scope of this review is to summarize current efforts in quality assurance for head and neck cancer surgery. National and international initiatives are summarized and progress in terms of identification of process indicators and outcome indicators delineated. RECENT FINDINGS Massive efforts have been made in order to improve quality of head and neck cancer surgery. New guidelines for quality assurance of head and neck cancer surgery in clinical trials have recently been proposed by EORTC. SUMMARY Quality assurance programs can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit from such initiatives on a global level.
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Appachi S, Shah J, Reddy C, Bowen A, Koyfman S, Lamarre E. Analysis of Process-Related Quality Metrics and Survival of Patients with Oral Cavity Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2019; 161:450-457. [DOI: 10.1177/0194599819845864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective To analyze the association of prior reported key quality metrics—neck dissection ≥18 nodes, radiation oncology referral for stage III/IV disease, unplanned surgery ≤14 days, and unplanned readmission ≤30 days—with disease-free survival (DFS) and overall survival (OS) in oral cavity cancer (OCC). Study Design A retrospective chart review. Setting A tertiary care center from 1995 to 2016. Subjects and Methods Data from patients with OCC who underwent primary surgery were studied. The association of quality metrics and pathology with DFS/OS was determined by Cox proportional hazards regression analysis. Results A total of 514 patients were included, and 398 (77.4%) underwent elective neck dissection. Key metrics were not associated with DFS on analysis, but higher pathologic stage and extracapsular extension (ECE) were. When stratified by stage, unplanned readmission within 30 days was associated with decreased survival on multivariate analysis (HR = 0.40; 95% CI, 0.20-0.85; P = .02) for patients with clinical stage III or IV disease. ECE was associated with decreased survival among these patients as well. Neck dissection with ≤18 nodes (HR = 0.62; 95% CI, 0.44-0.86; P = .004) and unplanned surgery within 14 days (HR = 0.56; 95% CI, 0.32-0.96; P = .03) were associated with decreased survival on univariate analysis but not on multivariate analysis. ECE and higher-stage disease were associated with decreased OS on multivariate analysis. Conclusion In this study, aggressive pathology, rather than adherence to key quality metrics, was associated with lower DFS and OS among patients with OCC. More studies are needed to elucidate the association of quality metrics with survival.
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Affiliation(s)
- Swathi Appachi
- Head and Neck Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Janki Shah
- Head and Neck Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Chandana Reddy
- Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Andrew Bowen
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Shlomo Koyfman
- Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric Lamarre
- Head and Neck Institute, The Cleveland Clinic, Cleveland, Ohio, USA
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de Kort WWB, Maas SLN, Van Es RJJ, Willems SM. Prognostic value of the nodal yield in head and neck squamous cell carcinoma: A systematic review. Head Neck 2019; 41:2801-2810. [PMID: 30969454 PMCID: PMC6767522 DOI: 10.1002/hed.25764] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/10/2019] [Accepted: 03/25/2019] [Indexed: 12/17/2022] Open
Abstract
Objective Literature analysis on the prognostic factor of the nodal yield (NY) in neck dissections (NDs), which in general surgical oncology is a strong prognosticator and quality‐of‐care marker. Methods We performed a systematic review of all PubMed and Embase publications until June 30, 2018 screening for data on NY as prognosticator and overall survival (OS) as outcome in patients with head and neck squamous cell carcinoma (HNSCC). Risk for bias was asserted by application of the Quality In Prognosis Studies tool. Results Of the 823 screened publications, 15 were included in this analysis. Five out of seven that compared NY ≥18 vs <18 as prognosticator, showed significantly improved survival if NY ≥18. Six studies used other cutoffs and three reported improved survival with each additionally harvested lymph node. Conclusion Increased NY in ND specimen for HNSCC, most commonly described as ≥18 lymph nodes, is associated with improved OS and could be used as a prognosticator and quality‐of‐care marker.
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Affiliation(s)
- Willem W B de Kort
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sybren L N Maas
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J Van Es
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Head and Neck Surgical Oncology, Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Chang S, Sanii R, Chaudhary H, Lewis C, Seidman M, Yaremchuk K. Evaluation of early oral cavity cancer treatment quality at a single institution. Laryngoscope 2018; 129:1816-1821. [PMID: 30408196 DOI: 10.1002/lary.27565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the adherence to oral cavity quality guidelines endorsed by the American Head and Neck Society (AHNS) at a large tertiary care hospital. METHODS This retrospective study identified patients treated for early-stage oral tongue squamous cell carcinoma at a tertiary care hospital from 1992 to 2013. Patient charts were reviewed for 26 process quality measures and four key indicator process quality measures as endorsed by the AHNS. Patients were then grouped by diagnosis date either before (historical group, 1992-2007) or after (current treatment group, 2008-2013) the published process quality measures from the AHNS. Descriptive statistics were used to evaluate the rates of adherence for each process quality measure within the 2 groups. RESULTS Of the 57 patients identified, 29 were female (51%). The mean age was 62.3 years. A majority of the oral cavity cancers were stage I (59.6%), followed by stage II (35.1%) and stage III (5.3%). Compliance with the process quality measures was in the acceptable range in both cohorts. However, several areas demonstrated lower adherence in both cohorts. Statistically significant improvements were noted between the two cohorts, which showed a measurable improvement in adherence to process quality measures in several key areas over time. CONCLUSION Using the process quality measures proposed by the AHNS, adherence to the process quality measures for early-stage oral cavity cancer care at a tertiary care center was successfully evaluated. In general, good compliance with the proposed process quality measures was found and several areas for improvement were identified. LEVEL OF EVIDENCE 2c Laryngoscope, 129:1816-1821, 2019.
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Affiliation(s)
- Steven Chang
- Department of Otolaryngology Head and Neck Surgery, Detroit, Michigan
| | - Ryan Sanii
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | | | - Carol Lewis
- Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Austin, Texas, U.S.A
| | - Michael Seidman
- Department of Otolaryngology Head and Neck Surgery, Detroit, Michigan
| | - Kathleen Yaremchuk
- Department of Otolaryngology Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan
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13
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Abstract
Performance improvement requires establishing a platform to set benchmarks and monitor the quality of care provided through quality indicators and metrics. This has long been recognized as critical to overall quality improvement and more recently, has become federally mandated. Here, we review recent studies evaluating performance in head and neck cancer care, from those spanning all phases of head and neck cancer care to others focused on head and neck surgical performance, including both national and departmental/institutional efforts.
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Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX, 77030, USA.
| | - Randal S Weber
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX, 77030, USA
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14
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Schoppy DW, Rhoads KF, Ma Y, Chen MM, Nussenbaum B, Orosco RK, Rosenthal EL, Divi V. Measuring Institutional Quality in Head and Neck Surgery Using Hospital-Level Data: Negative Margin Rates and Neck Dissection Yield. JAMA Otolaryngol Head Neck Surg 2017; 143:1111-1116. [PMID: 28983555 DOI: 10.1001/jamaoto.2017.1694] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Negative margins and lymph node yields (LNY) of 18 or more from neck dissections in patients with head and neck squamous cell carcinomas (HNSCC) have been associated with improved patient survival. It is unclear whether these metrics can be used to identify hospitals with improved outcomes. Objective To determine whether 2 patient-level metrics would predict outcomes at the hospital level. Design, Setting, and Participants A retrospective review of records from the National Cancer Database (NCDB) was used to identify patients who underwent primary surgery and concurrent neck dissection for HNSCC between 2004 and 2013. The percentage of patients at each hospital with negative margins on primary resection and an LNY 18 or more from a neck dissection was quantified. Cox proportional hazard models were used to define the association between hospital performance on these metrics and overall survival. Main Outcomes and Measures Margin status and lymph node yield at hospital level. Overall survival (OS). Results We identified 1008 hospitals in the NCDB where 64 738 patients met inclusion criteria. Of the 64 738 participants, 45 170 (69.8%) were men and 19 568 (30.2%) were women. The mean SD age of included patients was 60.5 (12.0) years. Patients treated at hospitals attaining the combined metric of a 90% or higher negative margin rate and 80% or more of cases with LNYs of 18 or more experienced a significant reduction in mortality (hazard ratio [HR] 0.93; 95% CI, 0.89-0.98). This benefit in survival was independent of the patient-level improvement associated with negative margins (HR, 0.73; 95% CI, 0.71-0.76) and LNY of 18 or more (HR, 0.85; 95% CI, 0.83-0.88). Including these metrics in the model neutralized the association of traditional measures of hospital quality (volume and teaching status). Conclusions and Relevance Treatment at hospitals that attain a high rate of negative margins and LNY of 18 or more is associated with improved survival in patients undergoing surgery for HNSCC. These surgical outcome measures predicted outcomes independent of traditional, but generally nonmodifiable characteristics. Tracking of these metrics may help identify high-quality centers and provide guidance for institution-level quality improvement.
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Affiliation(s)
- David W Schoppy
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| | | | - Yifei Ma
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| | - Michelle M Chen
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| | - Brian Nussenbaum
- Division of Head and Neck Surgery, Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ryan K Orosco
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| | - Eben L Rosenthal
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| | - Vasu Divi
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
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15
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Mallen-St. Clair J. Quality Metrics in Oral Cavity Cancer—Developing Standards for Optimal Lymph Node Yield. JAMA Otolaryngol Head Neck Surg 2017; 143:973-974. [DOI: 10.1001/jamaoto.2017.0978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Jon Mallen-St. Clair
- Department of Head and Neck Surgery, University of California-San Francisco, San Francisco
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16
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Graboyes EM, Garrett-Mayer E, Ellis MA, Sharma AK, Wahlquist AE, Lentsch EJ, Nussenbaum B, Day TA. Effect of time to initiation of postoperative radiation therapy on survival in surgically managed head and neck cancer. Cancer 2017; 123:4841-4850. [PMID: 28841234 DOI: 10.1002/cncr.30939] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objective of this study was to determine the effects of National Comprehensive Cancer Network (NCCN) guideline-adherent initiation of postoperative radiation therapy (PORT) and different time-to-PORT intervals on the overall survival (OS) of patients with head and neck squamous cell carcinoma (HNSCC). METHODS The National Cancer Data Base was reviewed for the period of 2006-2014, and patients with HNSCC undergoing surgery and PORT were identified. Kaplan-Meier survival estimates, Cox regression analysis, and propensity score matching were used to determine the effects of initiating PORT within 6 weeks of surgery and different time-to-PORT intervals on survival. RESULTS This study included 41,291 patients. After adjustments for covariates, starting PORT >6 weeks postoperatively was associated with decreased OS (adjusted hazard ratio [aHR], 1.13; 99% confidence interval [CI], 1.08-1.19). This finding remained in the propensity score-matched subset (hazard ratio, 1.21; 99% CI, 1.15-1.28). In comparison with starting PORT 5 to 6 weeks postoperatively, initiating PORT earlier was not associated with improved survival (aHR for ≤ 4 weeks, 0.93; 99% CI, 0.85-1.02; aHR for 4-5 weeks, 0.92; 99% CI, 0.84-1.01). Increasing durations of delay beyond 7 weeks were associated with small, progressive survival decrements (aHR, 1.09, 1.10, and 1.12 for 7-8, 8-10, and >10 weeks, respectively). CONCLUSIONS Nonadherence to NCCN guidelines for initiating PORT within 6 weeks of surgery was associated with decreased survival. There was no survival benefit to initiating PORT earlier within the recommended 6-week timeframe. Increasing durations of delay beyond 7 weeks were associated with small, progressive survival decrements. Cancer 2017;123:4841-50. © 2017 American Cancer Society.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth Garrett-Mayer
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Mark A Ellis
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Anand K Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Amy E Wahlquist
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Eric J Lentsch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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17
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Cramer JD, Speedy SE, Ferris RL, Rademaker AW, Patel UA, Samant S. National evaluation of multidisciplinary quality metrics for head and neck cancer. Cancer 2017; 123:4372-4381. [DOI: 10.1002/cncr.30902] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 11/06/2022]
Affiliation(s)
- John D. Cramer
- Department of Otolaryngology-Head and Neck Surgery; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Sedona E. Speedy
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Robert L. Ferris
- Department of Otolaryngology-Head and Neck Surgery; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Alfred W. Rademaker
- Department of Preventive Medicine; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Urjeet A. Patel
- Department of Otolaryngology-Head and Neck Surgery; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Sandeep Samant
- Department of Otolaryngology-Head and Neck Surgery; Northwestern University Feinberg School of Medicine; Chicago Illinois
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18
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Graboyes EM, Gross J, Kallogjeri D, Piccirillo JF, Al-Gilani M, Stadler ME, Nussenbaum B. Association of Compliance With Process-Related Quality Metrics and Improved Survival in Oral Cavity Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2017; 142:430-7. [PMID: 26869135 DOI: 10.1001/jamaoto.2015.3595] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Quality metrics for patients with head and neck cancer are available, but it is unknown whether compliance with these metrics is associated with improved patient survival. OBJECTIVE To identify whether compliance with various process-related quality metrics is associated with improved survival in patients with oral cavity squamous cell carcinoma who receive definitive surgery with or without adjuvant therapy. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at a tertiary academic medical center among 192 patients with previously untreated oral cavity squamous cell carcinoma who underwent definitive surgery with or without adjuvant therapy between January 1, 2003, and December 31, 2010. Data analysis was performed from January 26 to August 7, 2015. INTERVENTIONS Surgery with or without adjuvant therapy. MAIN OUTCOMES AND MEASURES Compliance with a collection of process-related quality metrics possessing face validity that covered pretreatment evaluation, treatment, and posttreatment surveillance was evaluated. Association between compliance with these quality metrics and overall survival, disease-specific survival, and disease-free survival was calculated using univariable and multivariable Cox proportional hazards analysis. RESULTS Among 192 patients, compliance with the individual quality metrics ranged from 19.7% to 93.6% (median, 82.8%). No pretreatment or surveillance metrics were associated with improved survival. Compliance with the following treatment-related quality metrics was associated with improved survival: elective neck dissection with lymph node yield of 18 or more, no unplanned surgery within 14 days of the index surgery, no unplanned 30-day readmissions, and referral for adjuvant radiotherapy for pathologic stage III or IV disease. Increased compliance with a "clinical care signature" composed of these 4 metrics was associated with improved overall survival, disease-specific survival, and disease-free survival on univariable analysis (log-rank test; P < .05 for each). On multivariable analysis controlling for pT stage, pN stage, extracapsular spread, margin status, and comorbidity, increased compliance with these 4 metrics was associated with improved overall survival (100% vs ≤50% compliance: adjusted hazard ratio [aHR], 4.2; 95% CI, 2.1-8.5; 100% vs 51%-99% compliance: aHR, 1.7; 95% CI, 1.0-3.1), improved disease-specific survival (100% vs ≤50% compliance: aHR, 3.9; 95% CI, 1.7-9.0; 100% vs 51%-99%: aHR, 1.3; 95% CI, 0.6-2.9), and improved disease-free survival (100% vs ≤50% compliance: aHR, 3.0; 95% CI, 1.5-5.8; 100% vs 51%-99% compliance: aHR, 1.6; 95% CI, 0.9-2.7). CONCLUSIONS AND RELEVANCE Compliance with a core set of process-related quality metrics was associated with improved survival for patients with surgically managed oral cavity squamous cell carcinoma. Multi-institutional validation of these metrics is warranted.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Jennifer Gross
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri2Editor, JAMA Otolaryngology-Head & Neck Surgery
| | - Maha Al-Gilani
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Michael E Stadler
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
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19
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Graboyes EM, Townsend ME, Kallogjeri D, Piccirillo JF, Nussenbaum B. Evaluation of Quality Metrics for Surgically Treated Laryngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2017; 142:1154-1163. [PMID: 27435696 DOI: 10.1001/jamaoto.2016.0657] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Quality metrics for patients with laryngeal squamous cell carcinoma (SCC) exist, but whether compliance with these metrics correlates with improved survival is unknown. Objective To examine whether compliance with proposed quality metrics is associated with improved survival in patients with laryngeal SCC treated with surgery with or without adjuvant therapy. Design, Setting, and Participants This retrospective cohort study included patients from a tertiary care academic medical center who had previously untreated laryngeal SCC and underwent surgery with or without adjuvant therapy from January 1, 2003, through December 31, 2012. Data analysis was performed from August 4, 2015, through December 13, 2015. Interventions Surgery with or without adjuvant therapy. Main Outcomes and Measures Compliance with quality metrics from the American Head and Neck Society (AHNS), National Comprehensive Cancer Network (NCCN) guidelines, and institutional metrics with face validity covering pretreatment evaluation, treatment, and posttreatment surveillance was evaluated. The association between compliance with the group of metrics and overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) was explored using Cox proportional hazards analysis. The association between compliance with individual metrics and survival was similarly determined. Results A total of 243 patients (184 men and 59 women) were included in the study (median age, 62 years; age range, 23-87 years). No association was found between increasing levels of compliance with the AHNS or NCCN metrics and survival. The only AHNS or NCCN metric for which greater compliance correlated with improved survival on multivariable Cox proportional hazards analysis controlling for pT stage, pN stage, extracapsular spread, margin status, and comorbidity was pretreatment multidisciplinary evaluation for patients with stage cT3-4 or cN1-3 disease (OS adjusted hazard ratio [aHR], 0.47; 95% CI, 0.24-0.94; DFS aHR, 0.45; 95% CI, 0.23-0.85). For the institutional metrics, multidisciplinary evaluation for all patients (OS aHR, 0.51; 95% CI, 0.29-0.88; DFS aHR, 0.50, 95% CI, 0.32-0.80) and elective neck dissection yield of 18 lymph nodes or more (DFS aHR, 0.36; 95% CI, 0.14-0.99) were associated with improved survival on multivariable Cox proportional hazards analysis. Conclusions and Relevance In this cohort of patients with surgically treated laryngeal SCC, multidisciplinary evaluation and elective neck dissection yield of 18 lymph nodes or more are associated with improved survival. Development of better quality metrics is necessary because increased compliance with metrics described by the AHNS and NCCN is not associated with improved survival. Previously described metrics for surgically treated oral cavity cancer are not prognostic for surgically treated laryngeal SCC. Future multi-institutional collaboration will be required to validate these findings, develop better quality metrics, and evaluate whether quality metrics for head and neck cancer are site specific.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Melanie E Townsend
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri2Editor, JAMA Otolaryngology-Head & Neck Surgery
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
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Abstract
The surgical method of margin sampling affects local control, pathologists' approach to margin sampling, and clarity of pathology reports. Studies have shown that exclusive reliance on tumor bed margins is associated with worse local control and should be avoided. En bloc resections and margins obtained from the resection specimen remain the "gold standard." Successful surgical treatment of early carcinomas of the oral cavity relies on close cooperation between surgeons and pathologists on issues of specimen orientation and margin sampling.
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21
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Divi V, Chen MM, Nussenbaum B, Rhoads KF, Sirjani DB, Holsinger FC, Shah JL, Hara W. Lymph Node Count From Neck Dissection Predicts Mortality in Head and Neck Cancer. J Clin Oncol 2016; 34:3892-3897. [DOI: 10.1200/jco.2016.67.3863] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Multiple smaller studies have demonstrated an association between overall survival and lymph node (LN) count from neck dissection in patients with head and neck cancer. This is a large cohort study to examine these associations by using a national cancer database. Patients and Methods The National Cancer Database was used to identify patients who underwent upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013. Patients were stratified by LN count into those with < 18 nodes and those with ≥ 18 nodes on the basis of prior work. A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality. Stratified models predicted hazard of mortality both for patients who were both node negative and node positive. Results There were 45,113 patients with ≥ 18 LNs and 18,865 patients with < 18 LNs examined. The < 18 LN group, compared with the ≥ 18 LN group, had more favorable tumor characteristics, with a lower proportion of T3 and T4 lesions (27.9% v 39.8%), fewer patients with positive nodes (46.6% v 60.5%), and lower rates of extracapsular extension (9.3% v 15.1%). Risk-adjusted Cox models predicting hazard of mortality by LN count showed an 18% increased hazard of death for patients with < 18 nodes examined (hazard ratio [HR] 1.18; 95% CI, 1.13 to 1.22). When stratified by clinical nodal stage, there was an increased hazard of death in both groups (node negative: HR, 1.24; 95% CI, 1.17 to 1.32; node positive: HR, 1.12; 95% CI, 1.05 to 1.19). Conclusion The results of our study demonstrate a significant overall survival advantage in both patients who are clinically node negative and node positive when ≥ 18 LNs are examined after neck dissection, which suggests that LN count is a potential quality metric for neck dissection.
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Affiliation(s)
- Vasu Divi
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michelle M. Chen
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Brian Nussenbaum
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kim F. Rhoads
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Davud B. Sirjani
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - F. Christopher Holsinger
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jennifer L. Shah
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Wendy Hara
- Vasu Divi, Michelle M. Chen, Kim F. Rhoads, Davud B. Sirjani, F. Christopher Holsinger, Jennifer L. Shah, and Wendy Hara, Stanford University Medical Center, Stanford; Vasu Divi and Davud B. Sirjani, Palo Alto VA, Palo Alto, CA; and Brian Nussenbaum, Washington University School of Medicine in St. Louis, St. Louis, MO
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22
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van Overveld LFJ, Braspenning JCC, Hermens RPMG. Quality indicators of integrated care for patients with head and neck cancer. Clin Otolaryngol 2016; 42:322-329. [PMID: 27537106 DOI: 10.1111/coa.12724] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Oncological 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 oncological care, a dashboard of valid and reliable quality indicators (QIs) is indispensable. The aim was to develop multidisciplinary QIs to measure quality of integrated oncological care, specifically for head and neck cancer (HNC) patients. DESIGN The RAND-modified Delphi method was used to decide on the outcome, process and structure QIs form three different perspectives. In addition, case-mix factors were determined. SETTING Integrated HNC in the Netherlands. PARTICIPANTS Head and neck cancer patients, chairmen of both patient organisations and medical specialists and allied health professionals involved in HNC care in the Netherlands. MAIN OUTCOME MEASURES Outcome, process and structure indicators. RESULTS Outcome indicators were assigned to healthcare status, tumour recurrence, complications, quality of life and patient experiences. The process indicators focused on the (allied health) care aspects during the diagnostic, treatment and follow-up phases, for example regarding waiting times, multidisciplinary team meetings and screening for the need of allied health care. CONCLUSIONS This is the first set of multidisciplinary QIs for HNC care, to assess quality of integrated care agreed by patients and professionals. This set can be used to build other oncological quality dashboards for integrated care.
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Affiliation(s)
- L F J van Overveld
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J C C Braspenning
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,The Netherlands Federation of University Medical Centres, NFU, Utrecht, The Netherlands
| | - R P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Maxwell JH, Thompson LDR, Brandwein-Gensler MS, Weiss BG, Canis M, Purgina B, Prabhu AV, Lai C, Shuai Y, Carroll WR, Morlandt A, Duvvuri U, Kim S, Johnson JT, Ferris RL, Seethala R, Chiosea SI. Early Oral Tongue Squamous Cell Carcinoma: Sampling of Margins From Tumor Bed and Worse Local Control. JAMA Otolaryngol Head Neck Surg 2016. [PMID: 26225798 DOI: 10.1001/jamaoto.2015.1351] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Positive margins are associated with poor prognosis among patients with oral tongue squamous cell carcinoma (SCC). However, wide variation exists in the margin sampling technique. OBJECTIVE To determine the effect of the margin sampling technique on local recurrence (LR) in patients with stage I or II oral tongue SCC. DESIGN, SETTING, AND PARTICIPANTS A retrospective study was conducted from January 1, 1986, to December 31, 2012, in 5 tertiary care centers following tumor resection and elective neck dissection in 280 patients with pathologic (p)T1-2 pN0 oral tongue SCC. Analysis was conducted from June 1, 2013, to January 20, 2015. INTERVENTIONS In group 1 (n = 119), tumor bed margins were not sampled. In group 2 (n = 61), margins were examined from the glossectomy specimen, found to be positive or suboptimal, and revised with additional tumor bed margins. In group 3 (n = 100), margins were primarily sampled from the tumor bed without preceding examination of the glossectomy specimen. The margin status (both as a binary [positive vs negative] and continuous [distance to the margin in millimeters] variable) and other clinicopathologic parameters were compared across the 3 groups and correlated with LR. MAIN OUTCOMES AND MEASURES Local recurrence. RESULTS Age, sex, pT stage, lymphovascular or perineural invasion, and adjuvant radiation treatment were similar across the 3 groups. The probability of LR-free survival at 3 years was 0.9 and 0.8 in groups 1 and 3, respectively (P = .03). The frequency of positive glossectomy margins was lowest in group 1 (9 of 117 [7.7%]) compared with groups 2 and 3 (28 of 61 [45.9%] and 23 of 95 [24.2%], respectively) (P < .001). Even after excluding cases with positive margins, the median distance to the closest margin was significantly narrower in group 3 (2 mm) compared with group 1 (3 mm) (P = .008). The status (positive vs negative) of margins obtained from the glossectomy specimen correlated with LR (P = .007), while the status of tumor bed margins did not. The status of the tumor bed margin was 24% sensitive (95% CI, 16%-34%) and 92% specific (95% CI, 85%-97%) for detecting a positive glossectomy margin. CONCLUSIONS AND RELEVANCE The margin sampling technique affects local control in patients with oral tongue SCC. Reliance on margin sampling from the tumor bed is associated with worse local control, most likely owing to narrower margin clearance and greater incidence of positive margins. A resection specimen-based margin assessment is recommended.
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Affiliation(s)
- Jessica H Maxwell
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Lester D R Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills
| | - Margaret S Brandwein-Gensler
- Division of Anatomic Pathology, Department of Pathology, The University of Alabama at Birmingham4Now with the Department of Pathology and Anatomical Sciences, State University of New York at the University at Buffalo and Erie County Medical Center, Buffal
| | - Bernhard G Weiss
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Göttingen, Göttingen, Germany
| | - Martin Canis
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Göttingen, Göttingen, Germany
| | - Bibianna Purgina
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Arpan V Prabhu
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Chi Lai
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Yongli Shuai
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - William R Carroll
- Department of Surgery, Head and Neck Oncology, The University of Alabama at Birmingham
| | - Anthony Morlandt
- Department of Surgery, Head and Neck Oncology, The University of Alabama at Birmingham
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania10Department of Otolaryngology, Veterans Affairs of Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raja Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Simion I Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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24
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Health Services Research and Regionalization of Care—From Policy to Practice: the Ontario Experience in Head and Neck Cancer. Curr Oncol Rep 2016; 18:19. [DOI: 10.1007/s11912-016-0500-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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25
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Eskander A, Monteiro E, Irish J, Gullane P, Gilbert R, de Almeida J, Brown D, Freeman J, Urbach DR, Goldstein DP. Adherence to guideline-recommended process measures for squamous cell carcinoma of the head and neck in Ontario: Impact of surgeon and hospital volume. Head Neck 2016; 38 Suppl 1:E1987-92. [DOI: 10.1002/hed.24364] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery; University Health Network, University of Toronto; Toronto Ontario Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head and Neck Surgery, Mt Sinai Hospital; University of Toronto; Toronto Ontario Canada
| | - Jonathan Irish
- Department of Otolaryngology - Head and Neck Surgery; University Health Network, University of Toronto; Toronto Ontario Canada
| | - Patrick Gullane
- Department of Otolaryngology - Head and Neck Surgery; University Health Network, University of Toronto; Toronto Ontario Canada
| | - Ralph Gilbert
- Department of Otolaryngology - Head and Neck Surgery; University Health Network, University of Toronto; Toronto Ontario Canada
| | - John de Almeida
- Department of Otolaryngology - Head and Neck Surgery; University Health Network, University of Toronto; Toronto Ontario Canada
| | - Dale Brown
- Department of Otolaryngology - Head and Neck Surgery; University Health Network, University of Toronto; Toronto Ontario Canada
| | - Jeremy Freeman
- Department of Otolaryngology - Head and Neck Surgery, Mt Sinai Hospital; University of Toronto; Toronto Ontario Canada
| | - David R. Urbach
- Division of General Surgery, Department of Surgery; University Health Network, University of Toronto; Toronto Ontario Canada
| | - David P. Goldstein
- Department of Otolaryngology - Head and Neck Surgery; University Health Network, University of Toronto; Toronto Ontario Canada
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26
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Lira RB, de Carvalho AY, de Carvalho GB, Lewis CM, Weber RS, Kowalski LP. Quality assessment in head and neck oncologic surgery in a Brazilian cancer center compared with MD Anderson Cancer Center benchmarks. Head Neck 2015; 38:1002-7. [DOI: 10.1002/hed.24304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 08/17/2015] [Accepted: 09/19/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Renan Bezerra Lira
- Head and Neck Surgery and Otorhinolaryngology Department; A.C. Camargo Cancer Center; São Paulo Brazil
| | - André Ywata de Carvalho
- Head and Neck Surgery and Otorhinolaryngology Department; A.C. Camargo Cancer Center; São Paulo Brazil
| | | | - Carol M. Lewis
- Department of Head and Neck Surgery; University of Texas, MD Anderson Cancer Center; Houston Texas
| | - Randal S. Weber
- Department of Head and Neck Surgery; University of Texas, MD Anderson Cancer Center; Houston Texas
| | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department; A.C. Camargo Cancer Center; São Paulo Brazil
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27
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Lewis CM, Hutcheson KA, Kupferman ME. Comparative effectiveness in head and neck malignancies. Cancer Treat Res 2015; 164:89-99. [PMID: 25677020 DOI: 10.1007/978-3-319-12553-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
To date, there is limited comparative effectiveness research (CER) in head and neck surgical oncology. Several barriers exist, the most common of which include low patient accrual, selection bias inherent to observational studies, and the difficulty of integrating both clinical and functional outcomes. Areas in need of meaningful CER range from initial evaluation to post-treatment surveillance, as well as the identification and evaluation of significant quality metrics and patient-reported outcomes. Despite existing hurdles, careful study design and statistical analyses can address current gaps in head and neck cancer care.
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Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, US,
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28
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Luryi AL, Chen MM, Mehra S, Roman SA, Sosa JA, Judson BL. Positive Surgical Margins in Early Stage Oral Cavity Cancer. Otolaryngol Head Neck Surg 2014; 151:984-90. [DOI: 10.1177/0194599814551718] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To report the incidence of positive surgical margins in early oral cavity cancer and identify patient, tumor, and system factors associated with their occurrence. Study Design and Setting Retrospective analysis of the National Cancer Database. Subjects and Methods Patients diagnosed with stage I or II oral cavity squamous cell cancer between 1998 and 2011 were identified. Univariate and multivariate analyses of factors associated with positive margins were conducted. Results In total, 20,602 patients with early oral cancer were identified. Margin status was reported in 94.8% of cases, and positive margins occurred in 7.5% of those cases. Incidence of positive margins by institution varied from 0% to 43.8%, with median incidence of 7.1%. Positive margins were associated with clinical factors including stage II disease (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.55-1.98), intermediate grade (OR, 1.20; 95% CI, 1.04-1.37), high grade (OR, 1.68; 95% CI, 1.39-2.03), and floor of mouth (OR, 1.78; 95% CI, 1.52-2.08), buccal mucosa (OR, 2.06; 95% CI, 1.59-2.68), and retromolar locations (OR, 2.40; 95% CI, 1.85-3.11). Positive margins were also associated with treatment at nonacademic cancer centers (OR, 1.23; 95% CI, 1.04-1.44) and institutions with a low oral cancer case volume (OR, 1.45; 95% CI, 1.23-1.69). Conclusion Positive margins are associated with tumor factors, including stage, grade, and site, reflecting disease aggressiveness and difficulty of resection. Positive margins also are associated with factors such as treatment facility type, hospital case volume, and geographic region, suggesting potential variation in quality of care. Margin status may be a useful quality measure for early oral cavity cancer.
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Affiliation(s)
- Alexander L. Luryi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michelle M. Chen
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sanziana A. Roman
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Julie A. Sosa
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Benjamin L. Judson
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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29
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Bonfante GMDS, Machado CJ, Souza PEAD, Andrade EIG, Acurcio FDA, Cherchiglia ML. [Specific 5-year oral cancer survival and associated factors in cancer outpatients in the Brazilian Unified National Health System]. CAD SAUDE PUBLICA 2014; 30:983-97. [PMID: 24936815 DOI: 10.1590/0102-311x00182712] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 11/06/2013] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the specific five-year oral cancer survival rate and associated factors in Brazil. This was a retrospective cohort study using the Oncological Database as the source, with probabilistic-deterministic linkage of all the records for authorization of radiotherapy and/or chemotherapy in the Unified National Health System from 2000 to 2006, generating a single record for each patient. The current study included patients diagnosed with oral cancer from 2002 to 2003 (except for cancer of lip), and ranging from 19 to 100 years of age (N = 6,180). Specific five-year survival was 60%. Decreased specific survival was associated with: age > 40 years; stages III or IV; location on the tongue, floor of the mouth, or base of the tongue; not performing surgical treatment, performing only chemotherapy or radiotherapy and chemotherapy; and residence in certain States of Brazil. The results emphasize the need to include assessment of regional disparities as a possibility for increasing health interventions and improving survival.
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30
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Eskander A, Irish J, Groome PA, Freeman J, Gullane P, Gilbert R, Hall SF, Urbach DR, Goldstein DP. Volume-outcome relationships for head and neck cancer surgery in a universal health care system. Laryngoscope 2014; 124:2081-8. [DOI: 10.1002/lary.24704] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 02/10/2014] [Accepted: 03/28/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology; Princess Margaret Cancer Centre; Toronto Ontario Canada
| | - Patti A. Groome
- Cancer Care and Epidemiology Division; Queen's Cancer Research Institute; Queen's University; Kingston Ontario Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Hospital; Toronto Ontario Canada
| | - Patrick Gullane
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology; Princess Margaret Cancer Centre; Toronto Ontario Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology; Princess Margaret Cancer Centre; Toronto Ontario Canada
| | - Stephen F. Hall
- Cancer Care and Epidemiology Division; Queen's Cancer Research Institute; Queen's University; Kingston Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery; Queen's University; Kingston Ontario Canada
| | - David R. Urbach
- Division of General Surgery; Department of General Surgery and Surgical Oncology; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology; Princess Margaret Cancer Centre; Toronto Ontario Canada
| | - David P. Goldstein
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology; Princess Margaret Cancer Centre; Toronto Ontario Canada
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31
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Talcott JA, Manola J, Chen RC, Clark JA, Kaplan I, D'Amico AV, Zietman AL. Using patient-reported outcomes to assess and improve prostate cancer brachytherapy. BJU Int 2014; 114:511-6. [DOI: 10.1111/bju.12464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- James A. Talcott
- Massachusetts General Hospital Cancer Center; Boston MA USA
- Continuum Cancer Centers of New York; New York NY USA
- Albert Einstein School of Medicine; New York NY USA
- Harvard Medical School; Boston MA USA
| | | | - Ronald C. Chen
- Department of Radiation Oncology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Jack A. Clark
- Center for Health Quality, Outcomes, and Economic Research; Edith Nourse Rogers Memorial Veterans Hospital; Bedford MA USA
- Boston University School of Public Health; Boston MA USA
| | - Irving Kaplan
- Beth Israel-Deaconess Medical Center; Boston MA USA
- Brigham and Women's Hospital; Boston MA USA
| | - Anthony V. D'Amico
- Brigham and Women's Hospital; Boston MA USA
- Harvard Medical School; Boston MA USA
| | - Anthony L. Zietman
- Department of Radiation Oncology; Massachusetts General Hospital; Boston MA USA
- Harvard Medical School; Boston MA USA
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32
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Leemans C, Tijink B, Langendijk J, Andry G, Hamoir M, Lefebvre J. Quality assurance in head and neck surgical oncology: EORTC 24954 trial on larynx preservation. Eur J Surg Oncol 2013; 39:1013-8. [DOI: 10.1016/j.ejso.2013.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 04/03/2013] [Accepted: 06/06/2013] [Indexed: 11/28/2022] Open
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Abstract
The Institute of Medicine has emphasized the roles of multidisciplinary treatment planning, evidence-based clinical practice guidelines, and regionalization of healthcare in optimizing the quality of cancer care. We discuss these critical elements as they pertain to head and neck cancer care.
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Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
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34
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Abstract
Improving the quality of health care has become a national priority, as indicated by the establishment of multiple federal initiatives and by the actions of national medical societies and the American Board of Medical Specialties. Health care can be assessed in each of three dimensions: structure, process, and outcomes. Here we review recent efforts to evaluate the quality of care delivered to head and neck cancer patients and to develop methods for improvement and continual assessment, with a particular emphasis on the evaluation of process of care.
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Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
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35
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Yamamoto N, Yamashita Y, Tanaka T, Ishikawa A, Kito S, Wakasugi-Sato N, Matsumoto-Takeda S, Oda M, Miyamoto I, Yamauchi K, Shiiba S, Seta Y, Matsuo K, Koga H, Takahashi T, Morimoto Y. Diagnostic significance of characteristic findings on ultrasonography for the stitch abscess after surgery in patients with oral squamous cell carcinoma. Oral Oncol 2011; 47:163-9. [DOI: 10.1016/j.oraloncology.2010.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 10/25/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
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