Head and neck cancer treatments often don't meet guidelines

2010 01 21 15 43 33 498 Salivary Glands 70

NEW YORK (Reuters Health) - Care for U.S. patients with head and neck cancers deviates significantly from national guidelines, if the findings of a new study hold true.

Researchers at Houston's MD Anderson Cancer Center saw a widespread lack of compliance with National Comprehensive Cancer Network guidelines when they reviewed the care patients received before coming to them with recurrent or persistent disease.

Out of 107 patients, 46 (43%) "had prereferral care that was not compliant with NCCN guidelines," Dr. Randal S. Weber and colleagues report in the December issue of Archives of Otolaryngology-Head & Neck Surgery.

Among these 46 patients, 27 (59%) received inadequate surgical treatment, seven (15%) refused appropriate recommendations, and five (11%) were treated for the wrong diagnosis, according to the report. Five patients received inadequate adjuvant therapy and two (4%) received inadequate radiation therapy.

Overall, the patients who received noncompliant care accounted for 8% of new patients between October 2008 and February 2009 (i.e., 8% of all patients and not just those with recurrent or persistent disease).

Patients' chances of inappropriate treatment were not affected by their insurance status, gender, ethnicity, referring provider type, or disease site, nor by whether radiation oncologists or endocrinologists were involved in their prereferral care.

Noncompliance with guidelines "may be due to lack of awareness on the part of practitioners of existence of guidelines and their importance for providing optimum cancer care," Dr. Weber told Reuters Health. But he added that lack of awareness is only one reason for the high rate of noncompliance.

"Reimbursement is not tied to providing care consistent with guidelines, and there is no disincentive for providing care that is not within guidelines," he said. "Finally, some practitioners may feel that they 'know what is best for their patient,' and do not need guidelines to dictate their management."

Dr. Weber said failures in prereferral treatment reduce the overall quality of care for the patient and raise health care costs considerably.

"'Do-overs' are very expensive and resource intensive," he said. "When a patient receives inappropriate treatment and is referred to us with recurrent cancer we expend significant resources in time, money and personnel to try to correct what has been done. Doing it correctly the first time provides the patient with the best opportunity for cure."

Improving compliance with guidelines will be a challenge, perhaps in part because head and neck cancers account for only 3% of all solid tumors in the U.S. Dr. Weber suggests sending patients to regional centers and centers of excellence to receive optimal care initially. Also, "don't pay for treatment inconsistent with guidelines unless there is clear documentation for departure from evidence-based care."

By Dave Levitan

Source: https://link.reuters.com/vez23r

Arch Otolaryngol Head Neck Surg 2010;136:1205-1211.

Last Updated: 2010-12-21 19:03:24 -0400 (Reuters Health)

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