National evaluation of multidisciplinary quality metrics for head and neck cancer. Issue 22 (20th July 2017)

• Record Type: Journal Article
• Authors: Cramer, John D.; Speedy, Sedona E.; Ferris, Robert L.; Rademaker, Alfred W.; Patel, Urjeet A.; Samant, Sandeep
• Is Part Of: Cancer. Volume 123:Issue 22(2017)
• Page Start: 4372
• Page End: 4381
• Publication Date: 2017-07-20
• Subjects: head and neck cancer -- head and neck neoplasms -- National Cancer Database -- quality -- surgery; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.30902
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: The National Quality Forum has endorsed quality‐improvement measures for multiple cancer types that are being developed into actionable tools to improve cancer care. No nationally endorsed quality metrics currently exist for head and neck cancer. METHODS: The authors identified patients with surgically treated, invasive, head and neck squamous cell carcinoma in the National Cancer Data Base from 2004 to 2014 and compared the rate of adherence to 5 different quality metrics and whether compliance with these quality metrics impacted overall survival. The metrics examined included negative surgical margins, neck dissection lymph node (LN) yield ≥ 18, appropriate adjuvant radiation, appropriate adjuvant chemoradiation, adjuvant therapy within 6 weeks, as well as overall quality. RESULTS: In total, 76, 853 eligible patients were identified. There was substantial variability in patient‐level adherence, which was 80% for negative surgical margins, 73.1% for neck dissection LN yield, 69% for adjuvant radiation, 42.6% for adjuvant chemoradiation, and 44.5% for adjuvant therapy within 6 weeks. Risk‐adjusted Cox proportional‐hazard models indicated that all metrics were associated with a reduced risk of death: negative margins (hazard ratio [HR] 0.73; 95% confidence interval [CI], 0.71‐0.76), LN yield ≥ 18 (HR, 0.93; 95% CI, 0.89‐0.96), adjuvant radiation (HR, 0.67; 95% CI, 0.64‐0.70), adjuvant chemoradiation (HR, 0.84; 95% CI, 0.79‐0.88), and adjuvant therapy ≤6 weeks (HR, 0.92; 95% CI, 0.89‐0.96). Patients who received high‐quality care had a 19% reduced adjusted hazard of mortality (HR, 0.81; 95% CI, 0.79‐0.83). CONCLUSIONS: Five head and neck cancer quality metrics were identified that have substantial variability in adherence and meaningfully impact overall survival. These metrics are appropriate candidates for national adoption. Cancer 2017;123:4372‐81 . © 2017 American Cancer Society . Abstract : Five different quality metrics for surgically resected head and neck cancer are identified that are measurable in cancer registries, under the influence of care providers, have widespread variation, and impact survival. These quality metrics meet criteria for validity and are candidates for more widespread adoption.