The Effect of Facility Volume on Treatment Guideline Compliance and Overall Survival in Oral Tongue Cancer
Purpose: Considering the increasing cost of health care, improving quality of care to maximize patient outcomes while containing cost is essential. National treatment guidelines guide cancer care using the best available evidence. Understanding the drivers of guideline compliance is an essential step to identifying modifiable factors to improve patient outcome. This study aims to explore the impact of facility volume on the rate of guideline compliance in patients with oral tongue cancer and its ultimate effect on overall survival. ^ Patients and Methods: Using National Cancer Database from 2004 to 2013, this retrospective cohort study investigated patients undergoing curative surgical treatment for oral tongue squamous cell carcinoma. Patients were divided into three categories according to mean annual case volume at their treatment facility. Guideline compliance was based on the National Comprehensive Cancer Network oral cavity cancer guidelines. Predictors of guideline compliance and overall survival were determined using multiple logistic regression and Cox Proportional Hazards models. ^ Results: Guideline compliant care was delivered in 54.5% of the 35,810 patients included in the study. Those treated at intermediate volume facilities had a 1.75 times greater odds of receipt of guideline compliant care (95% CI=1.57-1.96) and patients treated in high volume facilities had a 2.14 times greater odds of receipt of guideline compliant care (95% CI=1.91-2.40) compared to those treated in low volume facilities. Guideline compliance (adjusted hazard ratio [HRadj]=0.78, 95% CI=0.72-0.84) and treatment at a high case volume facility (HRadj=0.88, 95% CI=0.80—0.98) were significant predictors of overall survival. ^ Conclusion: Facility volume independently predicted guideline compliance in oral tongue cancer. Guideline compliance and treatment at a high case volume facility were predictors of overall survival. Clinicians should apply guideline compliant care regardless of practice setting and treatment at higher volume centers should be considered.^
Tam, Samantha, "The Effect of Facility Volume on Treatment Guideline Compliance and Overall Survival in Oral Tongue Cancer" (2017). Texas Medical Center Dissertations (via ProQuest). AAI10687874.