Adherence of head and neck squamous cell carcinoma patients to tumor board recommendations. (30th May 2020)

• Record Type: Journal Article
• Authors: Rangabashyam, Mahalakshmi S.; Lee, Shi Yan; Tan, Sher Yin; Mueller, Stefan; Sultana, Rehena; Ho, Johnatton; Skanthakumar, Thakshayeni; Tan, Ngian Chye; Tan, Hiang Khoon; Soo, Khee Chee; Iyer, N. Gopalakrishna
• Is Part Of: Cancer medicine. Volume 9:Number 14(2020)
• Page Start: 5124
• Page End: 5133
• Publication Date: 2020-05-30
• Subjects: adherence -- compliance -- Multidisciplinary team (MDT) -- outcomes -- survival -- therapy recommendations; 616.994005
• DOI: 10.1002/cam4.3097
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Background: Multidisciplinary team (MDT) meetings or tumor boards (TBs) are fundamental components of cancer treatment. Although their primary function is improved outcomes, this aspect is often underreported. The main objective of this study was to analyze the outcomes of patients with head and neck squamous cell carcinoma (HNSCC) discussed at TBs, and to compare the effect of adherence and nonadherence to recommended treatment plans on outcomes. Methods: Retrospective data analysis was conducted of HNSCC patients those who were adherent and nonadherent to TB therapy recommendations during 2008‐2009 at a comprehensive cancer center. Fisher's exact test and t test were used for group‐wise comparison, and Kaplan‐Meier and logistic regression models, for survival analysis and determination of the contributing factors to nonadherence. Results: Comprehensive Treatment plans were recommended by TBs in 293 HNSCC patients with curative intent. Seventy‐two patients were excluded based on the selection criteria. Among the remaining 221 patients, 172 (77.9%) were adherent to TB recommendations, while 49 (22.1%) failed to comply. Patient (n = 36; 73.5%), clinician (n = 2; 4.1%), and disease‐related (n = 11; 22.4%) factors were significant contributors to nonadherence. Mean (±standard deviation (SD)) survival time was 55.6 ± 2.32 and 29.1 ± 4 months in the adherent and nonadherent groups, ( P < .0001, respectively). Multivariate analyses showed that gender, ethnicity, higher T‐stage, and multimodal treatment were associated with nonadherence. Conclusion: Adherence to TB recommendations improved overall survival, reflecting the importance of interdisciplinary expertise in contemporary cancer treatment. Early identification and intervention is crucial in "at risk" patients to prevent subsequent drop‐out from optimal cancer care. Abstract : Despite the pivotal role that MDT TBs play in oncology care, the implementation of this science remains nebulous and has scope to improve. The need for standardising TB data reporting will enable to better understand HNC trends globally/regionally. Last but not the least, outcomes in HNC patients discussed at TBs and adherence of HNC patients to TB treatment plan is underreported, and analysis of this key area will be an essential cog in HNC patient management.