Multidisciplinary Quality Measures Identified for Head and Neck Cancer

07/24/17

Researchers have identified five quality metrics to help improve head and neck cancer care, published in Cancer (online July 20, 2017; doi:10.1002/cncr.30902).

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In recent years, the National Quality Forum have made efforts to improve cancer care by endorsing quality-improvement measures across multiple cancer types and developing them into actionable tools. However, no nationally endorsed quality metrics currently exist for head and neck cancer.

John D Cramer, MD, Department of Otolaryngology, Northwestern University (Chicago, IL), and colleagues conducted a study to compare rates of quality metric adherence among five different measurements. Researchers identified 76,853 eligible patients with surgically treated, invasive, head and neck squamous cell carcinoma in the National Cancer Data Base from 2004 to 2014. Examined metrics included negative surgical margins, neck dissection lymph node yield of at least 18, appropriate adjuvant radiation, appropriate adjuvant chemoradiation, and adjuvant therapy within 6 weeks, as well as overall quality.

After comparing the rates of adherence among these quality measures, researchers then assessed whether adherence impacted overall survival.

Researchers reported significant variability in patient-level adherence among the quality measures: 80% for negative surgical margins, 73.1% for neck dissection lymph node yield, 69% for adjuvant radiation, 42.6% for adjuvant chemoradiation, and 44.5% for adjuvant therapy within 6 weeks.

Additionally, risk-adjusted Cox proportional-hazard models indicated that all five metrics were associated with reduced risk of death: negative margins (HR, 0.73; 95% CI, 0.71-0.76), lymph node yield of at least 18 (HR, 0.93; 95% CI, 0.89-0.96), adjuvant radiation (HR, 0.67; 95% CI, 0.64-0.70), adjuvant chemoradiation (HR, 0.84; 95% CI, 0.79-0.88), and adjuvant therapy within 6 weeks (HR, 0.92; 95% CI, 0.89-0.96). Those who received high-quality care had a 19% reduced adjusted hazard of mortality (HR, 0.81; 95% CI, 0.79-0.83).

Researchers concluded that the five identified quality metrics demonstrated meaningful impact on overall survival. “These metrics are appropriate candidates for national adoption,” they wrote.—Zachary Bessette