title: Adherence to National Comprehensive Cancer Network guidelines for time to initiation of postoperative radiation therapy for patients with head and neck cancer.
abstract: BACKGROUND
  Adherence to evidence-based treatment guidelines has been proposed as a measure of cancer care quality. The objective of this study was to determine the rate and predictors of care that does not adhere to National Comprehensive Cancer Network guidelines regarding commencing postoperative radiation therapy (PORT) within 6 weeks of surgery for patients with head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  The National Cancer Data Base was reviewed from 2006 to 2014, and patients with HNSCC who underwent curative-intent surgery followed by PORT were identified. Multivariable logistic regression analysis was used to determine the factors associated with nonadherence to guidelines regarding the timing of initiating PORT.
  
  
  RESULTS
  In total, 47,273 patients were included in the study. 55.7% of patients (26,340/47,273) failed to commence PORT within 6 week of surgery. The percentage of patients who failed to initiate PORT within 6 week of surgery increased over time. On multivariable analysis, the factors associated with failure to initiate timely, guideline-adherent PORT included black race, public insurance [Medicare, Medicaid] or uninsured status, lower levels of education, increased severity of comorbidity, increased postoperative length of stay, 30-day unplanned hospital readmission, treatment at an academic medical center, and the receipt of surgery and PORT at different facilities.
  
  
  CONCLUSIONS
  Over 50% of patients with HNSCC who undergo surgery and PORT receive care that does not adhere to National Comprehensive Cancer Network guidelines with regard to initiating PORT within 6 weeks of surgery. Sociodemographic, oncologic, treatment, and hospital factors are all associated with failure to receive guideline-directed care and should be explored in future studies. Cancer 2017;123:2651-60. © 2017 American Cancer Society.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Evan M
authors.identifier: http://orcid.org/0000-0003-3766-468X
authors.initials: EM
authors.lastname: Graboyes
authors.affiliation: Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Garrett-Mayer
authors.affiliation: Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Anand K
authors.initials: AK
authors.lastname: Sharma
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lentsch
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Day
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D015897:Comorbidity; D016208:Databases, Factual; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D013517:Otorhinolaryngologic Surgical Procedures; D010359:Patient Readmission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck; D013997:Time Factors; D014481:United States
keywords: NCNN guidelines; National Cancer Data Base; National Comprehensive Cancer Network (NCCN); adherence to guidelines; head and neck quality; quality of care