Quality of care and short‐ and long‐term outcomes of laryngeal cancer care in the elderly

Gourin, Christine G.; Starmer, Heather M.; Herbert, Robert J.; Frick, Kevin D.; Forastiere, Arlene A.; Quon, Harry; Eisele, David W.; Dy, Sydney M.

doi:10.1002/lary.25378

Cited by 31 publications

(48 citation statements)

References 28 publications

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“…Above all, higher quality is associated with lower complications, shorter length of stay, and less readmissions, ultimately leading to lower associated costs [25,[32][33][34][35][36][37]. Higher quality of care is better for patients but it is also cheaper for our health-care system, and during these trying economic times, we should strive to improve both.…”

Section: Resultsmentioning

confidence: 94%

“…In this cohort, prior to presentation at a tertiary care center, 43 % of patient's initial care deviated from guideline recommendations [24]. Using the SEER database and looking at a group of elderly patients with larynx cancer, Gourin et al demonstrated that patients receiving higher quality of care (i.e., higher compliance with guideline recommendations) were associated with improved survival on multivariate analysis [25]. This is the only study to link higher quality of care and adherence to guideline recommendations with outcomes.…”

Section: Beyond the Volume-outcome Relationshipmentioning

confidence: 96%

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Health Services Research and Regionalization of Care—From Policy to Practice: the Ontario Experience in Head and Neck Cancer

2016

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Patients being treated at higher case volume hospitals or by higher case volume physicians appear to have better outcomes. This volume-outcome relationship is reviewed for oncologic and non-oncologic surgery with a focus on head and neck oncology. The impact of these research findings on health policy and health-care organization in Ontario, Canada, is then outlined. Lastly, future directions for quality improvement in surgical oncology are reviewed in the context of a universal health-care system. These include surgeon report cards, pre-operative checklists, linking funding and remuneration to the quality of delivered care, and the use of process improvement techniques.

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Section: Resultsmentioning

confidence: 94%

Section: Beyond the Volume-outcome Relationshipmentioning

confidence: 96%

Health Services Research and Regionalization of Care—From Policy to Practice: the Ontario Experience in Head and Neck Cancer

2016

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“…12–15 What has been published for oral cavity cancer assesses compliance with a variety of metrics but does not correlate compliance with an outcome. 12 Published studies for larynx cancer have been limited to elderly patients, and most of the metrics were related to surveillance, management of recurrent disease, and end-of-life care.…”

Section: Discussionmentioning

confidence: 99%

“…12 Published studies for larynx cancer have been limited to elderly patients, and most of the metrics were related to surveillance, management of recurrent disease, and end-of-life care. 14,15 None of the above-referenced studies assessed how performance of specific quality metrics was associated with survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

Association of Compliance With Process-Related Quality Metrics and Improved Survival in Oral Cavity Squamous Cell Carcinoma

Graboyes

Gross

Kallogjeri

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Quality metrics for patients with head and neck cancer are available, but it is unknown whether compliance with these metrics is associated with improved patient survival. OBJECTIVE To identify whether compliance with various process-related quality metrics is associated with improved survival in patients with oral cavity squamous cell carcinoma who receive definitive surgery with or without adjuvant therapy. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at a tertiary academic medical center among 192 patients with previously untreated oral cavity squamous cell carcinoma who underwent definitive surgery with or without adjuvant therapy between January 1, 2003, and December 31, 2010. Data analysis was performed from January 26 to August 7, 2015. INTERVENTIONS Surgery with or without adjuvant therapy. MAIN OUTCOMES AND MEASURES Compliance with a collection of process-related quality metrics possessing face validity that covered pretreatment evaluation, treatment, and posttreatment surveillance was evaluated. Association between compliance with these quality metrics and overall survival, disease-specific survival, and disease-free survival was calculated using univariable and multivariable Cox proportional hazards analysis. RESULTS Among 192 patients, compliance with the individual quality metrics ranged from 19.7% to 93.6% (median, 82.8%). No pretreatment or surveillance metrics were associated with improved survival. Compliance with the following treatment-related quality metrics was associated with improved survival: elective neck dissection with lymph node yield of 18 or more, no unplanned surgery within 14 days of the index surgery, no unplanned 30-day readmissions, and referral for adjuvant radiotherapy for pathologic stage III or IV disease. Increased compliance with a “clinical care signature” composed of these 4 metrics was associated with improved overall survival, disease-specific survival, and disease-free survival on univariable analysis (log-rank test; P < .05 for each). On multivariable analysis controlling for pT stage, pN stage, extracapsular spread, margin status, and comorbidity, increased compliance with these 4 metrics was associated with improved overall survival (100% vs ≤50% compliance: adjusted hazard ratio [aHR], 4.2; 95% CI, 2.1-8.5; 100% vs 51%-99% compliance: aHR, 1.7; 95% CI, 1.0-3.1), improved disease-specific survival (100% vs ≤50% compliance: aHR, 3.9; 95% CI, 1.7-9.0; 100% vs 51%-99%: aHR, 1.3; 95% CI, 0.6-2.9), and improved disease-free survival (100% vs ≤50% compliance: aHR, 3.0; 95% CI, 1.5-5.8; 100% vs 51%-99% compliance: aHR, 1.6; 95% CI, 0.9-2.7). CONCLUSIONS AND RELEVANCE Compliance with a core set of process-related quality metrics was associated with improved survival for patients with surgically managed oral cavity squamous cell carcinoma. Multi-institutional validation of these metrics is warranted.

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“…9–14 The published studies 7,8 of quality metrics for laryngeal cancer have focused on elderly patients and included patients treated with surgical and nonsurgical approaches. In addition, the metrics were related primarily to surveillance, management of recurrent disease, and end-of-life care and did not find a graded response between increasing levels of compliance and the outcome of interest.…”

mentioning

confidence: 99%

Evaluation of Quality Metrics for Surgically Treated Laryngeal Squamous Cell Carcinoma

Graboyes

Townsend

Kallogjeri

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Quality metrics for patients with laryngeal squamous cell carcinoma (SCC) exist, but whether compliance with these metrics correlates with improved survival is unknown. OBJECTIVE To examine whether compliance with proposed quality metrics is associated with improved survival in patients with laryngeal SCC treated with surgery with or without adjuvant therapy. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients from a tertiary care academic medical center who had previously untreated laryngeal SCC and underwent surgery with or without adjuvant therapy from January 1, 2003, through December 31, 2012. Data analysis was performed from August 4, 2015, through December 13, 2015. INTERVENTIONS Surgery with or without adjuvant therapy. MAIN OUTCOMES AND MEASURES Compliance with quality metrics from the American Head and Neck Society (AHNS), National Comprehensive Cancer Network (NCCN) guidelines, and institutional metrics with face validity covering pretreatment evaluation, treatment, and posttreatment surveillance was evaluated. The association between compliance with the group of metrics and overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) was explored using Cox proportional hazards analysis. The association between compliance with individual metrics and survival was similarly determined. RESULTS A total of 243 patients (184 men and 59 women) were included in the study (median age, 62 years; age range, 23–87 years). No association was found between increasing levels of compliance with the AHNS or NCCN metrics and survival. The only AHNS or NCCN metric for which greater compliance correlated with improved survival on multivariable Cox proportional hazards analysis controlling for pT stage, pN stage, extracapsular spread, margin status, and comorbidity was pretreatment multidisciplinary evaluation for patients with stage cT3-4 or cN1-3 disease (OS adjusted hazard ratio [aHR], 0.47; 95% CI, 0.24–0.94; DFS aHR, 0.45; 95% CI, 0.23–0.85). For the institutional metrics, multidisciplinary evaluation for all patients (OS aHR, 0.51; 95% CI, 0.29–0.88; DFS aHR, 0.50, 95% CI, 0.32–0.80) and elective neck dissection yield of 18 lymph nodes or more (DFS aHR, 0.36; 95% CI, 0.14–0.99) were associated with improved survival on multivariable Cox proportional hazards analysis. CONCLUSIONS AND RELEVANCE In this cohort of patients with surgically treated laryngeal SCC, multidisciplinary evaluation and elective neck dissection yield of 18 lymph nodes or more are associated with improved survival. Development of better quality metrics is necessary because increased compliance with metrics described by the AHNS and NCCN is not associated with improved survival. Previously described metrics for surgically treated oral cavity cancer are not prognostic for surgically treated laryngeal SCC. Future multi-institutional collaboration will be required to validate these findings, develop better quality metrics, and evaluate whether quality metrics for head ...

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Quality of care and short‐ and long‐term outcomes of laryngeal cancer care in the elderly

Abstract: 2c.

Cited by 31 publications

References 28 publications

Health Services Research and Regionalization of Care—From Policy to Practice: the Ontario Experience in Head and Neck Cancer

Health Services Research and Regionalization of Care—From Policy to Practice: the Ontario Experience in Head and Neck Cancer

Association of Compliance With Process-Related Quality Metrics and Improved Survival in Oral Cavity Squamous Cell Carcinoma

Evaluation of Quality Metrics for Surgically Treated Laryngeal Squamous Cell Carcinoma

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