Lewis Carol M, Hessel Amy C, Roberts Dianna B, Guo Yunxia Z, Holsinger F Christopher, Ginsberg Lawrence E, El-Naggar Adel K, Weber Randal S
Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
Arch Otolaryngol Head Neck Surg. 2010 Dec;136(12):1205-11. doi: 10.1001/archoto.2010.206.
to evaluate the prereferral treatment of patients referred to our tertiary care center with recurrent or persistent head and neck cancer for compliance with National Comprehensive Cancer Network (NCCN) guidelines.
a prospective recruitment and retrospective chart review.
the study included new patients identified at multidisciplinary treatment planning conference from October 1, 2008, to February 1, 2009, who had received prior treatment at an outside institution and presented to our department with recurrent or persistent disease.
all facets of prior care were examined, including the time from initial symptoms to diagnosis and whether their prereferral treatment was compliant with or deviated from NCCN guidelines for head and neck cancer.
a total of 566 consecutive new patients were identified, of whom 107 (18.9%) had persistent or recurrent disease. The average time from first presentation with initial symptoms to diagnosis among patients who presented with persistent disease was 23.8 weeks. Nearly half of the patients who presented with persistent or recurrent disease had either endocrine (21.5%) or cutaneous (24.2%) primary cancers, with the rest of the cases being distributed among 10 other sites. Of the patients who presented with recurrent or persistent disease, 43.0% had prereferral care that was noncompliant with NCCN guidelines. Of these patients, 58.7% had inadequate surgical management, 15.2% were treated for the wrong diagnosis, 10.9% received inadequate adjuvant therapy, 4.4% received inadequate radiotherapy, and 10.9% refused indicated recommended treatment.
significant deviation from NCCN guidelines for head and neck cancer treatment was observed in the cohort of study patients. The failure to administer adjuvant therapy when indicated by NCCN guidelines is particularly concerning. Economic and noneconomic costs, including lost wages, cost of "do-over" therapy, and potentially diminished survival, are substantial. Measures to ensure that patients receive therapy according to guidelines should be a national priority.
评估转诊至我们三级医疗中心的复发性或持续性头颈癌患者的转诊前治疗情况，以确定其是否符合美国国立综合癌症网络（NCCN）指南。
前瞻性招募和回顾性病历审查。
本研究纳入了2008年10月1日至2009年2月1日在多学科治疗计划会议上确定的新患者，这些患者曾在外部机构接受过先前治疗，并因复发性或持续性疾病就诊于我们科室。
检查先前治疗的各个方面，包括从初始症状出现到诊断的时间，以及他们的转诊前治疗是否符合或偏离NCCN头颈癌指南。
共确定了566例连续的新患者，其中107例（18.9%）患有持续性或复发性疾病。持续性疾病患者从首次出现初始症状到诊断的平均时间为23.8周。近一半患有持续性或复发性疾病的患者患有内分泌（21.5%）或皮肤（24.2%）原发性癌症，其余病例分布在其他10个部位。在患有复发性或持续性疾病的患者中，43.0%的患者转诊前治疗不符合NCCN指南。在这些患者中，58.7%的患者手术管理不足，15.2%的患者因错误诊断接受治疗，10.9%的患者辅助治疗不足，4.4%的患者放疗不足，10.9%的患者拒绝接受推荐的治疗。
在研究队列中观察到与NCCN头颈癌治疗指南存在显著偏差。NCCN指南指示应进行辅助治疗时却未进行，这一点尤其令人担忧。经济和非经济成本巨大，包括工资损失、“重新治疗”的费用以及可能缩短的生存期。确保患者按照指南接受治疗的措施应成为国家优先事项。
