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Article Title

Process-Related Quality Measures of Early- and Late-Stage Laryngeal Cancer Care

Publication Date

8-15-2016

Keywords

head and neck cancer, outcomes and quality

Abstract

Background/Aims: The purpose of this study was to evaluate the quality measures established by the American Head and Neck Society (AHNS) quality committee. The measures were intended to assess quality care in treating laryngeal cancer beyond the traditional measures of survival and locoregional control. This study also attempted to identify specific measures from within AHNS guidelines that may relate to locoregional control and/or survival.

Methods: Retrospective review of patients with laryngeal cancer at a tertiary, academic center between 1991 and 2012. Patients were divided into early stage and late stage based on American Joint Committee on Cancer staging and analyzed separately. The major measures of quality, including overall survival, proper staging of the tumor prior to initiation of treatment, documentation of adverse pathology features (perineural invasion, lymphovascular invasion, positive margin, extracapsular spread), appropriate referral for adjuvant therapy (radiation and/or chemotherapy) and proper adherence to follow-up per National Comprehensive Cancer Network guidelines, were examined. The influence of these measures on survival also was analyzed.

Results: A total of 806 cases of laryngeal cancer were identified. Of those, 76.9% had proper documentation of tumor-node-metastasis staging. Of the 602 staged, 56% were early stage and 44% were late stage, 55% had documentation of adverse pathology, 52% were given appropriate referral for radiation therapy and 70% had appropriate follow-up. There was a statistically significant difference in survival for those patients who received appropriate initial staging when compared to nonstaged cases. This significance persisted when controlling for early- versus late-stage cases.

Conclusion: This study supports the validity of process-related quality measures from the AHNS. This is the first study of head and neck cancers suggesting that process-related measures can influence outcome measures such as overall survival.

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