Age-related differences in guideline adherence for head and neck cancer

Objective:The aim of this study was to examine which factors influence guideline adherence and to determine the impact of non-adherence on survival.Materials and methods:Cohort of 606 patients (median age 65.3 years) newly diagnosed with head and neck cancer at Medical Centre Alkmaar between 1997 and 2009. Treatment was compared to guideline recommendations. Multivariable analyses were performed to determine factors associated with non-adherence and associated outcome.Results:Ninety-one percent of patients were treated in accordance with guidelines for head and neck cancer. Reasons for discordant treatment were comorbidity, lack of cooperation in patients aged < 70 years, and patients' refusal to undergo recommended treatment. Age (OR 1.40, 95% CI 1.04–1.87), comorbidity (OR 1.68, 95% CI 1.32–2.13) and advanced disease (OR 1.83, 95% CI 1.46–2.28) were independently associated with non-adherence. Five-year overall survival was 64% for accordant treatment and 16% for discordant treatment (p < 0.001). Higher age (HR 1.03, 95% CI 1.01–1.04), advanced stage (HR 1.36, 95% CI 1.21–1.53), recurrent disease (HR 3.29, 95% CI 1.97–5.52) and treatment discordant with guidelines (HR 3.22, 95% CI 2.15–4.85) were independently associated with cancer-specific mortality.Conclusion:Discordance with guidelines occurred in less than 10% of patients at our centre and was associated with age, tumour stage, comorbidity, and a significantly poorer cancer-specific survival.