title: Receipt of Care Discordant with Practice Guidelines is Associated with Compromised Overall Survival in Nasopharyngeal Carcinoma.
abstract: OBJECTIVE
  It is unknown whether receiving treatment that is discordant with practice guidelines is associated with improved survival in patients with nasopharyngeal carcinoma. The objectives of this study were to characterise national treatment patterns, analyse whether treatment outside of practice guidelines is associated with overall survival, and identify variables associated with receiving guidelines-discordant care in the USA.
  
  
  METHODS
  This was a retrospective cohort study of 1741 nasopharyngeal carcinoma patients in the National Cancer Data Base (2003-2006). Treatment regimens were compared with the 2004-2006 National Comprehensive Cancer Network guidelines. Statistical analyses included chi-square, Kaplan-Meier, multivariable logistic, and Cox regression.
  
  
  RESULTS
  Nearly 26% of our cohort received care discordant with practice guidelines. In multivariable analysis, patients with stage IVC disease (odds ratio 2.59, 95% confidence interval 1.66-4.04) were more likely to receive guidelines-discordant care when compared with those with stage II-IVB disease. The most common treatment deviation for those with stage I disease was overtreatment with chemoradiation therapy. Receiving guidelines-discordant care was associated with an increased risk of death (hazard ratio 1.46, 95% confidence interval 1.25-1.69).
  
  
  CONCLUSIONS
  Many patients with stages I and IVC nasopharyngeal carcinoma do not receive care in accordance with practice guidelines. Receiving guidelines-discordant care is associated with compromised overall survival in the USA.
authors: Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, USA. Electronic address: zachary.schwam@yale.edu.
authors: Z G
authors: ZG
authors: Schwam
authors: Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
authors: J A
authors: JA
authors: Sosa
authors: Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
authors: S
authors: S
authors: Roman
authors: Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, CT, USA.
authors: B L
authors: BL
authors: Judson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma; D059248:Chemoradiotherapy / Q000401:mortality*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic / Q000592:standards*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D059039:Standard of Care / Q000639:trends*; D015996:Survival Rate; D055815:Young Adult
keywords: Head and neck cancer; National Cancer Data Base; nasopharyngeal carcinoma; practice guideline