title: An international comparison of the management of the neck in early oral squamous cell carcinoma in the Netherlands, UK, and USA.
abstract: BACKGROUND
  Early oral cavity squamous cell carcinoma (OCSCC) management appears to vary both within and between countries. Variation in practice can be an indicator of absence of evidence-based management and may negatively influence survival and morbidity. The exact variation and the relationship to differences in guidelines are unknown. This study aimed to report on these variations in the Netherlands, UK, and USA, and to evaluate them.
  
  
  METHODS
  Information regarding the variation in OCSCC management strategies was obtained from a questionnaire sent to representatives of head and neck cancer centers in the Netherlands, UK, and USA. Within-country and between-country variations were also assessed in light of the different guidelines.
  
  
  RESULTS
  In total, representatives of 45 centers completed the questionnaire; 10 from the Netherlands, 26 from the UK and 9 from the USA. Our results demonstrate a distinct variation in the diagnoses, treatment and follow-up of OCSCC, both within and between countries. Only a small amount of variation between countries could be linked to differences in guidelines.
  
  
  CONCLUSIONS
  There is high variation in the management of the neck in OCSCC. There seem to be a need for direct evidence about optimal management decisions to establish more evidence-based management and uniform practice.
authors.affiliation: Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Tim.Govers@radboudumc.nl.
authors.forename: Tim M
authors.initials: TM
authors.lastname: Govers
authors.affiliation: Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Tijs B H
authors.initials: TB
authors.lastname: de Kort
authors.affiliation: Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Matthias A W
authors.initials: MA
authors.lastname: Merkx
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Stefan C A
authors.initials: SC
authors.lastname: Steens
authors.affiliation: Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands; Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Maroeska M
authors.initials: MM
authors.lastname: Rovers
authors.affiliation: Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, UMCU Utrecht, Utrecht, The Netherlands.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000628:therapy; D009333:Neck; D009426:Netherlands; D017410:Practice Guidelines as Topic; D006113:United Kingdom; D014481:United States
keywords: Evidence-based management; International comparison; Neck management; Oral cavity squamous cell carcinoma; Practice variation