title: Effect of an evidence-based guideline on the treatment of maxillofacial cancer: A prospective analysis.
abstract: BACKGROUND
  In 2012, a guideline for the diagnosis and treatment of oral cavity cancer based on the best available evidence was implemented at certified German cancer centres for head and neck carcinomas. The present analysis was performed to determine whether the implementation of the guideline via certification improved the level of care, leading to a benefit for the patients.
  
  
  METHODS
  A prospective observational study was performed based on the annual operating figures at 31 certified head and neck cancer centres. From 76 statements and recommendations, 9 indicators were derived defining important steps during treatment. The annual shift of the figures was documented for each indicator and was used to measure the impact of the guideline. This was achieved by determining the number of patients having received the recommended treatment related to the total number in each centre over a period of 3 years.
  
  
  RESULTS
  In 2014, 1570 primary cases with an oral cavity carcinoma were treated at our centres, 31.2% representing stage IVA. Except for two, all indicators showed increasing numbers of achievement from 2012 to 2014, reaching median values between 91% and 100% in 2014. In particular, median values for imaging and interdisciplinary treatment to evaluate the presence of second primaries and metastases increased by 20% and 30%, respectively. Median values decreased by 14% for recommended adjuvant radiation, because of non-acceptance by the patients. Moreover, elective neck dissection was performed less frequently in cN0 categories.
  
  
  CONCLUSIONS
  Implementation of the national cancer guideline by means of certification evidently had a positive impact on patients suffering from oral squamous cell carcinoma and led to the improved achievement of most evidence-based treatment recommendations over time. Further research involving high-level clinical studies is needed to cover all aspects of this specific tumour entity.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Klaus-Dietrich
authors.initials: KD
authors.lastname: Wolff
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany. Electronic address: andrea.rau@gmx.net.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rau
authors.affiliation: OnkoZert GmbH, Neu-Ulm, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Ferencz
authors.affiliation: German Cancer Society, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Langer
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Kesting
authors.affiliation: Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Nieberler
authors.affiliation: German Cancer Society, Berlin, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Wesselmann
mesh_terms: D002173:Cancer Care Facilities; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002568:Certification; D059186:Chemoradiotherapy, Adjuvant; D004502:Education, Medical, Continuing; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005858:Germany; D019983:Guideline Adherence; D006258:Head and Neck Neoplasms; D006801:Humans; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D037981:Neck Dissection / Q000706:statistics & numerical data; D009367:Neoplasm Staging / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant
keywords: Analysis; Cancer; Guideline; Maxillofacial