Adherence of head and neck squamous cell carcinoma patients to tumor board recommendations.
Multidisciplinary team (MDT)
adherence
compliance
outcomes
survival
therapy recommendations
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
16
02
2020
accepted:
15
04
2020
pubmed:
31
5
2020
medline:
14
5
2021
entrez:
31
5
2020
Statut:
ppublish
Résumé
Multidisciplinary team (MDT) meetings or tumor boards (TBs) are fundamental components of cancer treatment. Although their primary function is improved outcomes, this aspect is often underreported. The main objective of this study was to analyze the outcomes of patients with head and neck squamous cell carcinoma (HNSCC) discussed at TBs, and to compare the effect of adherence and nonadherence to recommended treatment plans on outcomes. Retrospective data analysis was conducted of HNSCC patients those who were adherent and nonadherent to TB therapy recommendations during 2008-2009 at a comprehensive cancer center. Fisher's exact test and t test were used for group-wise comparison, and Kaplan-Meier and logistic regression models, for survival analysis and determination of the contributing factors to nonadherence. Comprehensive Treatment plans were recommended by TBs in 293 HNSCC patients with curative intent. Seventy-two patients were excluded based on the selection criteria. Among the remaining 221 patients, 172 (77.9%) were adherent to TB recommendations, while 49 (22.1%) failed to comply. Patient (n = 36; 73.5%), clinician (n = 2; 4.1%), and disease-related (n = 11; 22.4%) factors were significant contributors to nonadherence. Mean (±standard deviation (SD)) survival time was 55.6 ± 2.32 and 29.1 ± 4 months in the adherent and nonadherent groups, (P < .0001, respectively). Multivariate analyses showed that gender, ethnicity, higher T-stage, and multimodal treatment were associated with nonadherence. Adherence to TB recommendations improved overall survival, reflecting the importance of interdisciplinary expertise in contemporary cancer treatment. Early identification and intervention is crucial in "at risk" patients to prevent subsequent drop-out from optimal cancer care.
Sections du résumé
BACKGROUND
Multidisciplinary team (MDT) meetings or tumor boards (TBs) are fundamental components of cancer treatment. Although their primary function is improved outcomes, this aspect is often underreported. The main objective of this study was to analyze the outcomes of patients with head and neck squamous cell carcinoma (HNSCC) discussed at TBs, and to compare the effect of adherence and nonadherence to recommended treatment plans on outcomes.
METHODS
Retrospective data analysis was conducted of HNSCC patients those who were adherent and nonadherent to TB therapy recommendations during 2008-2009 at a comprehensive cancer center. Fisher's exact test and t test were used for group-wise comparison, and Kaplan-Meier and logistic regression models, for survival analysis and determination of the contributing factors to nonadherence.
RESULTS
Comprehensive Treatment plans were recommended by TBs in 293 HNSCC patients with curative intent. Seventy-two patients were excluded based on the selection criteria. Among the remaining 221 patients, 172 (77.9%) were adherent to TB recommendations, while 49 (22.1%) failed to comply. Patient (n = 36; 73.5%), clinician (n = 2; 4.1%), and disease-related (n = 11; 22.4%) factors were significant contributors to nonadherence. Mean (±standard deviation (SD)) survival time was 55.6 ± 2.32 and 29.1 ± 4 months in the adherent and nonadherent groups, (P < .0001, respectively). Multivariate analyses showed that gender, ethnicity, higher T-stage, and multimodal treatment were associated with nonadherence.
CONCLUSION
Adherence to TB recommendations improved overall survival, reflecting the importance of interdisciplinary expertise in contemporary cancer treatment. Early identification and intervention is crucial in "at risk" patients to prevent subsequent drop-out from optimal cancer care.
Identifiants
pubmed: 32472749
doi: 10.1002/cam4.3097
pmc: PMC7367636
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
5124-5133Informations de copyright
© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Références
Lancet Oncol. 2006 Nov;7(11):951-4
pubmed: 17081921
Ann Surg Oncol. 2011 Dec;18(13):3535-43
pubmed: 21594706
Ann Oncol. 2015 Jul;26(7):1325-32
pubmed: 25605751
Am J Otolaryngol. 2013 Jan-Feb;34(1):57-60
pubmed: 23218113
Otolaryngol Head Neck Surg. 2010 Nov;143(5):650-4
pubmed: 20974334
Onkologie. 2005 Jan;28(1):22-6
pubmed: 15616378
Oral Oncol. 2013 Sep;49(9):872-877
pubmed: 23830839
Lancet. 1975 May 31;1(7918):1205-7
pubmed: 48832
Nat Rev Clin Oncol. 2019 Apr;16(4):205-206
pubmed: 30552396
Semin Plast Surg. 2010 Aug;24(3):331-4
pubmed: 22550455
Eur J Cancer Care (Engl). 2019 Jul;28(4):e13062
pubmed: 31025800
Eur J Cancer Care (Engl). 2019 Mar;28(2):e12973
pubmed: 30511450
Cancer Med. 2020 Jul;9(14):5124-5133
pubmed: 32472749
Head Neck. 2015 Jul;37(7):1046-50
pubmed: 24710807
Otolaryngol Head Neck Surg. 2012 Sep;147(3):404-6
pubmed: 22687328
Cancer Treat Rev. 2016 Jan;42:56-72
pubmed: 26643552
Eur J Surg Oncol. 2019 Jan;45(1):40-45
pubmed: 29478741
Curr Oncol. 2012 Aug;19(4):e232-8
pubmed: 22876151
Oral Oncol. 2016 Aug;59:73-79
pubmed: 27424185
Oral Maxillofac Surg Clin North Am. 2018 Nov;30(4):435-444
pubmed: 30173901
Eur Ann Otorhinolaryngol Head Neck Dis. 2015 Sep;132(4):213-5
pubmed: 26139415
Psychooncology. 2018 Jan;27(1):106-113
pubmed: 28603876
Int J Surg. 2013;11(5):389-94
pubmed: 23500030
JAMA Oncol. 2016 Nov 1;2(11):1421-1426
pubmed: 27415765
BMC Cancer. 2018 Sep 29;18(1):936
pubmed: 30268109
Curr Treat Options Oncol. 2018 Oct 1;19(11):59
pubmed: 30276480
Curr Opin Oncol. 2004 May;16(3):220-4
pubmed: 15069316
Laryngoscope. 2016 Mar;126(3):627-31
pubmed: 26267427
Acta Otolaryngol. 2018 Feb;138(2):185-189
pubmed: 28978255
Curr Opin Nephrol Hypertens. 1994 May;3(3):271-8
pubmed: 7922252
Int J Technol Assess Health Care. 1995 Summer;11(3):443-55
pubmed: 7591546
Soc Sci Med. 1992 Mar;34(5):507-13
pubmed: 1604357
J Clin Pharm Ther. 2001 Oct;26(5):331-42
pubmed: 11679023
Br J Cancer. 2011 Apr 12;104(8):1246-8
pubmed: 21448166