JAMA Otol Logo Orlando 2013 AHNS Meeting Location
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American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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ASSESSMENT OF ORAL CAVITY AND LARYNGEAL CANCER QUALITY MEASURES IN A REGIONAL HEAD AND NECK TUMOR CLINIC

Presentation: P048
Topic: Clinical - Gen. Head & Neck Surgery
Type: Poster
Date: Wednesday - Thursday, April 10 - 11, 2013
Session: Designated Poster viewing times
Authors: Matthew G Yantis, MD, Peter Hunt, MD
Institution(s): University of Tennessee Health Science Center-Chattanooga

Intro-The Chattanooga Tumor Clinic is a multi-disciplinary, non-profit cancer clinic that serves cancer patients without healthcare insurance. Head and neck cancer patients comprise a portion of the clinic population. The goal of our study was to assess the quality of care being delivered to the laryngeal and oral cavity cancer patients using the American Head and Neck Society’s (AHNS) 2009 Quality of Care Committee recommendations for treatment of these subsites.

Methods- A retrospective chart review was conducted and pertinent data were collected from 89 patients treated in the Chattanooga Tumor Clinic with a total of 91 head and neck cancers from the past 10 years. Relevant data points that were recorded and analyzed included cancer histology, treatment types with dates of treatment initiation, follow up and pertinent risk factors such as smoking and drinking history. Next, the treatment data from the laryngeal and oral cavity cancer patients were cross-referenced with the recommendations made in the 2009 AHNS Quality of Care document.

Results- Of the 89 patients, 21 of them had oral cavity cancer, and 9 had laryngeal cancer with average ages of 54 and 49, respectively. Oral cavity pre-treatment measures: All patients had appropriate pathology confirming disease as well as TNM staging prior to treatment. 19 of 21 patients (90%) had been given smoking cessation counseling per documentation. Oral cavity treatment measures: All patients with advanced disease (T>2) were referred to radiation oncology, and all patients with positive tumor margins and/or extranodal extension were referred to medical oncology and radiation oncology. Oral cavity post-treatment measures: All patients had appropriate follow-up tumor surveillance. None of the 11 patients (0%) receiving XRT had a documented TSH level within 12 months post radiation.

Laryngeal pre-treatment measures: All patients had pathology confirming disease and proper TNM staging prior to treatment. 8 of 9 (88%) had their T determined by both exam and radiology. 7 of 9 (77%) had documentation of smoking cessation counseling. 3 of the 5 patients (60%) scheduled for laryngectomy had documented pre-laryngectomy counseling. Laryngeal treatment measures: All patients with advanced disease were referred to medical oncology, including those with positive margins or extranodal extension or greater than 1 positive lymph node. Laryngeal post-treatment measures: All patients had appropriate follow-up post treatment. None of the 7 patients (0%) receiving XRT had a documented TSH level within 12 months post radiation. 4 of the 5 patients (80%) treated by laryngectomy had documented referral to speech pathology.


Discussion-The Chattanooga Tumor Clinic provides high-quality care for head and neck cancer patients. The clinic is in compliance with the majority of recommendations made by the AHNS Quality of Care Committee. The main areas in need of improvement include smoking cessation, post radiation TSH levels, and pre-laryngectomy counseling. We plan to implement a “checklist” sheet to be placed in all laryngeal and oral cavity cancer patient charts, which will contain the AHNS quality of care metrics, in order to improve our compliance and patient quality of care.




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