Guideline - Adherence in advanced stage head and neck cancer is associated with improved survival – A National study

•Despite improvement in recent years, adherence rates remain suboptimal, around 75%•Adherence to NCCN guidelines is associated with improved survival, regardless of treatment modality.•Different non-adherence causes result in reduced overall survival compared with adherent patients. Understanding th...

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Published in:Oral oncology 2022-02, Vol.125, p.105694-105694, Article 105694
Main Authors: Cohen, Oded, Brauer, Philip R., Judson, Benjamin L., Burtness, Barbara A., Earles, Joseph, Mehra, Saral
Format: Article
Language:English
Subjects:
Adherence
Blacks
Female
Guideline Adherence
Head and Neck Cancer
Head and Neck Neoplasms - therapy
Humans
National Cancer Database
NCCN
Proportional Hazards Models
Radiation
Retrospective Studies
Surgery
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Summary:•Despite improvement in recent years, adherence rates remain suboptimal, around 75%•Adherence to NCCN guidelines is associated with improved survival, regardless of treatment modality.•Different non-adherence causes result in reduced overall survival compared with adherent patients. Understanding the prevalence of guideline non-adherence among patients with advanced head and neck cancer (HNC) and its impact on survival may facilitate increased adherence. Our objective was to perform a detailed analysis of overall National Comprehensive Care Network (NCCN) guideline adherence in a national cohort. Using the National Cancer Database, we analyzed site-specific NCCN guideline adherence for treatment of 100,074 overall stage III and IVA HNC patients from 2004 to 2013. Main outcomes were guideline adherence rates and overall survival (OS). Adherence was categorized by treatment: surgery/ radiation. Reasons were categorized as: (1) high risk; (2) refusal; (3) not planned. After exclusion, the care of 25,620 patients was defined as non-adherent (25.6%), yet adherence rates significantly improved across the study’s years. After multivariate analysis, non-adherence was associated with age ≥ 65, female gender, black race, comorbidity score ≥ 1, insurance status, clinical staging, primary site, and facility type. Patients not managed according to NCCN guidelines had a significantly reduced OS compared with patients treated on-guideline (hazard ratio (HR) = 1.51 (95 %CI 1.48–1.54), p 
ISSN:1368-8375
1879-0593
DOI:10.1016/j.oraloncology.2021.105694