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Article Title

Quality Measures in Early Stage Oral Cavity Squamous Cell Carcinoma

Publication Date

4-30-2015

Keywords

head and neck cancer, quality

Abstract

Background/Aims: Head and neck cancer treatment practices and outcomes vary from institution to institution. Other than survival data, there has been no established method to evaluate an institution’s quality of cancer care. To address this issue, the American Head and Neck Society (AHNS) developed quality guidelines for head and neck cancer care based on systematic literature review and expert opinion. These guidelines represent critical aspects of accepted standards of oral cancer care, and the presence or absence of these measures is most likely to affect the overall outcome regardless of patient comorbidity. The purpose of this study is to evaluate the quality of oral tongue cancer care at our institution and validate these established quality measures.

Methods: A retrospective chart review of 73 patients treated at Henry Ford Health System with stage I–III oral tongue squamous cell carcinoma from 1991 to 2012 was performed, using 26 clinical measures based on AHNS quality guidelines. Correlations between parameters and endpoints were assessed by the Pearson chi-square test or, when there were < 10 subjects in any cell of a 2 × 2 grid, by the two-tailed Fisher exact test.

Results: Of the 26 measures, 4 major measures were established. These were postoperative TNM staging (95.2% compliance rate), documentation of margin status in pathology reporting (93.6%), appropriate referral for radiation postoperatively based on NCCN guidelines (96.8%), and neck dissection based on > 4 mm depth of invasion of the primary (performed in 84.5% of the qualifying patients). Overall 5-year survival for patients evaluated before 2007 was 58%. Of the 26 clinical endpoints, a majority of demographic and social history information was present with a compliance of 95%. However, other clinical endpoints such as preoperative speech pathology evaluation or dental evaluation had compliance rates of < 20%.

Discussion: We were able to successfully review our own practice, validate the AHNS quality measures and identify areas that require improvement. This provides support to the validity of the major measures of quality head and neck cancer care established by the AHNS.

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