title: Head and neck cancer in India: need to formulate uniform national treatment guideline?
abstract: BACKGROUND
  In a large and diverse country like India, there is a wide variation in the availability of infrastructure and expertise to treat head-neck cancer patients. Lack of consistent adherence to evidence-based management is the biggest problem.
  
  
  OBJECTIVE
  There is an unmet need to evaluate the existing treatment practices to form the basis for development of effective and uniform treatment policies.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  A group of previously treated, potentially curable patients presenting to our institution (from April 2009 to March 2011) were evaluated for appropriateness of initial treatment based on National Comprehensive Cancer Network or Tata Memorial Hospital guidelines. Data regarding treatment center, protocol and accuracy of delivered treatment and their eventual outcome were analyzed.
  
  
  METHODS
  Descriptive.
  
  
  RESULTS
  Amongst 450 newly registered patients, 77(17%) were previously treated with curative intent and 69(89%) of them were inappropriately treated. Seventeen (25%) patients were treated in clinics while 12(17%) in cancer centers and 34(50%) in corporate hospitals. Fourteen (20%) patients received chemotherapy, 22(32%) received radiotherapy and 14(20%) underwent surgery while 19(28%) patients received multimodality treatment. Disease stage changed to more advanced stage in 40(58%) patients and curative intent treatment could be offered only to 33(48%) patients. Amongst 56 patients available for outcome review, 18(32%) patients were alive disease-free, 20(36%) had died and 18(32%) were alive with disease.
  
  
  CONCLUSIONS
  Large numbers of potentially curable patients are inappropriately treated and their outcome is significantly affected. Many initiatives have been taken in the existing National Cancer Control Program but formulation of a uniform national treatment guideline should be prioritized.
authors: Department of Head and Neck Oncology, Mazumdar-Shaw Cancer Center, Narayana Hrudayalaya, Bangalore, India.
authors: N P
authors: NP
authors: Trivedi
authors: V D
authors: VD
authors: Kekatpure
authors: N N
authors: NN
authors: Trivedi
authors: M A
authors: MA
authors: Kuriakose
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods / Q000592:standards*; D018450:Disease Progression; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D006287:Health Planning Guidelines; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome