Department of Otorhinolaryngology-Head and Neck Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Radiology and Nuclear Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
Cancer. 2020 Sep 1;126(17):3982-3990. doi: 10.1002/cncr.33037. Epub 2020 Jul 7.
Timely and efficient diagnostic workup of patients with head and neck cancer (HNC) is challenging. This observational study describes the implementation of an optimized multidisciplinary oncological diagnostic workup for patients with HNC and its impact on diagnostic and treatment intervals, survival, costs, and patient satisfaction.
All patients with newly diagnosed HNC who underwent staging and treatment at the Radboud University Medical Center were included. Conventional workup (CW) in 2009 was compared with the fast-track, multidisciplinary, integrated care program, that is, optimized workup (OW), as implemented in 2014.
The study included 486 patients with HNC (218 with CW and 268 with OW). The time-to-treatment interval was significantly lower in the OW cohort than the CW cohort (21 vs 34 days; P < .0001). The 3-year overall survival rate was 12% higher after OW (72% in the CW cohort vs 84% in the OW cohort; P = .002). After correction for confounders, the 3-year risk of death remained significantly lower in the OW cohort (hazard ratio, 1.73; 95% confidence interval, 1.14-2.63; P = .010). Total diagnostic costs were comparable in the 2 cohorts. The general satisfaction score, as measured with the Consumer Quality Index for Oncological Care, was significantly better in a matched OW group than the CW group (9.1 vs 8.5; P = .007).
After the implementation of a fast-track, multidisciplinary, integrated care program, the time-to-treatment interval was significantly reduced. Overall survival and patient satisfaction increased significantly, whereas costs did not change. This demonstrates the impact and improved quality of care achieved by efficiently organizing the diagnostic phase of HNC management.
及时有效地对头颈部癌症（HNC）患者进行诊断具有挑战性。本观察性研究描述了一种优化的多学科肿瘤学诊断方案在 HNC 患者中的实施情况，以及其对诊断和治疗间隔、生存、成本和患者满意度的影响。
纳入在 Radboud 大学医学中心接受分期和治疗的所有新诊断为 HNC 的患者。将 2009 年的常规检查（CW）与 2014 年实施的快速通道、多学科、综合护理计划（即优化检查（OW））进行比较。
本研究共纳入 486 例 HNC 患者（CW 组 218 例，OW 组 268 例）。OW 组的治疗时间间隔明显短于 CW 组（21 天 vs 34 天；P<0.0001）。OW 组 3 年总生存率比 CW 组高 12%（CW 组为 72%，OW 组为 84%；P=0.002）。在校正混杂因素后，OW 组 3 年死亡风险仍显著降低（风险比，1.73；95%置信区间，1.14-2.63；P=0.010）。两组的诊断总成本相当。在匹配的 OW 组中，消费者肿瘤护理质量指数（Consumer Quality Index for Oncological Care）测量的总体满意度评分明显高于 CW 组（9.1 分 vs 8.5 分；P=0.007）。
实施快速通道、多学科、综合护理计划后，治疗时间间隔明显缩短。总体生存率和患者满意度显著提高，而成本没有变化。这表明通过有效组织 HNC 管理的诊断阶段，可以显著提高医疗质量并改善护理效果。
