Clinical practice guidelines for dental management prior to radiation for head and neck cancer

BackgroundClinical practice guidelines (cpgs) are systematically developed statements designed to assist practitioners and patients in making decisions about appropriate heath care interventions. Clinical practice guidelines are expensive and time-consuming to create. A cpg on concurrent chemotherapy with radiation therapy (ccrt) was developed in Ontario at a time when treatment approaches for head-and-neck cancer were changing significantly.MethodsAn assessment of treatments and outcomes based on electronic and chart data obtained from a population-based study of 571 patients with oropharynx cancer treated in Ontario (2003–2004) was combined with a review of relevant knowledge transfer (publications and presentations at major meetings) to understand variation in adherence to a cpg.ResultsIn 9 Ontario cancer treatment centres, ccrt was used for 55% of all patients with oropharyngeal cancer; however, at the centres individually, that proportion ranged from 82% to 39%. Furthermore, there was no agreement on the chemotherapy regimen: 2–4 years later (a period during which newer regimens were emerging), only 4 of 9 centres were following the guideline for most patients. When outcomes of treated patients were compared for centres with “higher” and “lower” use of ccrt, no difference in survival was observed (p = 0.64).ConclusionsAt a time of treatment evolution, the new guideline was controversial, and there are many reasons for the mixed adherence. An estimation of adherence should be included during both development and review of guidelines.

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AHNS Series - Do you know your guidelines?: Assessment and management of malnutrition in patients with head and neck cancer: Review of the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines)

Head & Neck ◽

10.1002/hed.24866 ◽

2018 ◽

Vol 41 (3) ◽

pp. 577-583 ◽

Cited By ~ 6

Author(s):

Amarbir Gill ◽

Babak Givi ◽

Michael G. Moore

Keyword(s):

Head And Neck Cancer ◽

Clinical Practice ◽

Head And Neck ◽

Neck Cancer ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Nccn Guidelines ◽

Cancer Review

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Dental Restrictions to Clinical Practice during the COVID-19 Pandemic: An Australian Perspective

JDR Clinical & Translational Research ◽

10.1177/23800844211000341 ◽

2021 ◽

pp. 238008442110003

Author(s):

T.M. Nguyen ◽

U. Tonmukayakul ◽

H. Calache

Keyword(s):

Head And Neck Cancer ◽

Clinical Practice ◽

Dental Caries ◽

Knowledge Transfer ◽

Head And Neck ◽

Neck Cancer ◽

Dental Care ◽

Oral Diseases ◽

Increased Risk ◽

Dental Profession

The coronavirus disease 2019 (COVID-19) has disrupted essential oral healthcare in Australia. Sources for COVID-19 transmission via dental settings is considered to have high potential due to the production of aerosols and because transmission can occur through the airborne route. However, COVID-19 cases in dentistry is reportedly low. Delayed timely dental care, where severe oral diseases remain undetected, untreated, or asymptomatic such as advanced dental caries, periodontitis, and head and neck cancer, can have detrimental consequences for individuals at increased risk for oral diseases. The dental profession should remain vigilant and advocate for the continuation of essential oral healthcare even in times of uncertainty. Knowledge Transfer Statement: The reportedly low COVID-19 transmission occurring in dental settings highlight achievements made by the dental profession. There are valid reasons to reconsider risk-based essential oral healthcare during the COVID-19 pandemic.

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Quality Improvement in Otolaryngology–Head and Neck Surgery: Developing Registry-Enabled Quality Measures From Guidelines for Cerumen Impaction and Allergic Rhinitis Through a Transparent and Systematic Process

Otolaryngology ◽

10.1177/01945998211011987 ◽

2021 ◽

pp. 019459982110119

Author(s):

Jeremy J. Michel ◽

Seth R. Schwartz ◽

Douglas E. Dawson ◽

James C. Denneny ◽

Eileen Erinoff ◽

...

Keyword(s):

Allergic Rhinitis ◽

Clinical Practice ◽

Head And Neck ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Clinical Care ◽

Quality Measures ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Quality Reporting

Background and Significance Quality measurement can drive improvement in clinical care and allow for easy reporting of quality care by clinicians, but creating quality measures is a time-consuming and costly process. ECRI (formerly Emergency Care Research Institute) has pioneered a process to support systematic translation of clinical practice guidelines into electronic quality measures using a transparent and reproducible pathway. This process could be used to augment or support the development of electronic quality measures of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) and others as the Centers for Medicare and Medicaid Services transitions from the Merit-Based Incentive Payment System (MIPS) to the MIPS Value Pathways for quality reporting. Methods We used a transparent and reproducible process to create electronic quality measures based on recommendations from 2 AAO-HNSF clinical practice guidelines (cerumen impaction and allergic rhinitis). Steps of this process include source material review, electronic content extraction, logic development, implementation barrier analysis, content encoding and structuring, and measure formalization. Proposed measures then go through the standard publication process for AAO-HNSF measures. Results The 2 guidelines contained 29 recommendation statements, of which 7 were translated into electronic quality measures and published. Intermediate products of the guideline conversion process facilitated development and were retained to support review, updating, and transparency. Of the 7 initially published quality measures, 6 were approved as 2018 MIPS measures, and 2 continued to demonstrate a gap in care after a year of data collection. Conclusion Developing high-quality, registry-enabled measures from guidelines via a rigorous reproducible process is feasible. The streamlined process was effective in producing quality measures for publication in a timely fashion. Efforts to better identify gaps in care and more quickly recognize recommendations that would not translate well into quality measures could further streamline this process.

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Tonsillektomia w populacji pediatrycznej – główne wskazania, aktualne wytyczne Amerykańskiej Akademii Otolaryngologów Chirurgów Głowy i Szyi

Nowa Pediatria ◽

10.25121/np.2019.23.4.132 ◽

2019 ◽

Vol 23 (4) ◽

Author(s):

Anna Wierzbicka-Rot ◽

Artur Gadomski

Keyword(s):

Clinical Practice ◽

American Academy ◽

Head And Neck ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Postoperative Care ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Evidence Based ◽

Practical Information

In February 2019 American Academy of Otolaryngology-Head and Neck Surgery published clinical practice guidelines which provides evidence-based recommendations that applies to children under consideration for tonsillectomy. This update to the 2011 publication includes large amount of new, practical information about pre-, intra- and postoperative care and management, that can be useful for surgeons as well as GPs and pediatricians

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Is GRADE the Right Choice for Clinical Practice Guidelines Developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation?

Otolaryngology ◽

10.1177/0194599819846458 ◽

2019 ◽

Vol 161 (1) ◽

pp. 3-5

Author(s):

Andrés M. Bur ◽

Richard M. Rosenfeld

Keyword(s):

Clinical Practice ◽

American Academy ◽

Head And Neck ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Current Knowledge ◽

Clinical Care ◽

Neck Surgery ◽

Head And Neck Surgery ◽

The Right

Clinical practice guidelines (CPGs), developed to inform clinicians, patients, and policy makers about what constitutes optimal clinical care, are one way of increasing implementation of evidence into clinical practice. Many factors must be considered by multidisciplinary guideline panels, including strength of available evidence, limitations of current knowledge, risks/benefits of interventions, patient values, and limited resources. Grading of Recommendations Assessment, Development and Evaluation (GRADE) is a framework for summarizing evidence that has been endorsed by many national and international organizations for developing CPGs. But is GRADE the right choice for CPGs developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF)? In this commentary, we will introduce GRADE, discuss its strengths and limitations, and address the question of what potential benefits GRADE might offer beyond existing methodology used by the AAO-HNSF in developing CPGs.

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The effect of dental management for maintaining dental health in patients with head and neck cancer after radiotherapy

Toukeibu Gan ◽

10.5981/jjhnc.35.266 ◽

2009 ◽

Vol 35 (3) ◽

pp. 266-272

Author(s):

Kouji Katsura ◽

Sanae Goto ◽

Keisuke Sasai ◽

Katsuro Sato ◽

Masahiko Tomita ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Dental Health ◽

Dental Management

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Adaptive radiotherapy for head and neck cancer: Are we ready to put it into routine clinical practice?

Oral Oncology ◽

10.1016/j.oraloncology.2018.08.010 ◽

2018 ◽

Vol 86 ◽

pp. 19-24 ◽

Cited By ~ 3

Author(s):

Michael F. Gensheimer ◽

Quynh-Thu Le

Keyword(s):

Head And Neck Cancer ◽

Clinical Practice ◽

Head And Neck ◽

Neck Cancer ◽

Routine Clinical Practice ◽

Adaptive Radiotherapy

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Compliance and Outcomes in Locally Advanced Head and Neck Cancer Patients Treated with Alternating Chemoradiotherapy in Clinical Practice

Tumori Journal ◽

10.1177/030089160308900105 ◽

2003 ◽

Vol 89 (1) ◽

pp. 20-25 ◽

Cited By ~ 4

Author(s):

Vittorio Franciosi ◽

Marco Fumagalli ◽

Luciana Biscari ◽

Roberto Martinelli ◽

Teore Ferri ◽

...

Keyword(s):

Overall Survival ◽

Head And Neck Cancer ◽

Clinical Practice ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Locally Advanced ◽

Hematologic Toxicity ◽

Advanced Head ◽

Grade 3

Background and Aims To evaluate the feasibility in clinical practice of alternating chemo-radiotherapy in locally advanced head and neck cancer patients. Patients and Methods From August 1993 to April 1998 at the Division of Medical Oncology of Parma, 48 consecutive patients were observed, and 38 (79%) started the Merlano chemo-radiotherapy. The characteristics of the patients were: males (32, 84%); median age, 57 years; PS <2 (32, 84%). The primary sites were the oropharynx (18, 47%), oral cavity (8, 21%), hypopharynx (7, 19%), larynx (5, 13%); stage IV disease was present in 29 (76%) patients. Twenty-five (66%) patients were married, and 24 (63%) resided outside of the city. Results The compliance was very low: 21 patients (55%) performed all the programmed cycles of chemotherapy, whereas only 5 patients (13%) performed the chemo-radiotherapy at full doses without any delay. The objective responses were 3 (8%) complete and 21 (55%) complete plus partial responses. Failures were 2 (5%) stable disease and 2 (5%) progressive disease, and the response was not assessable in 10 (26%). The median duration of the response was 8 months. The median overall survival and the time to progression were 18 and 13 months, respectively; the 5-year overall and relapse-free survival were 36% and 26%, respectively. Nine (24%) patients were still alive as of August 30, 2001, 8 (21%) of them without progression. Twenty-six patients (68%) died with a local-regional relapse. One patient (3%) died for a second cancer. Grade 3–4 hematologic toxicity was leukopenia (n = 25, 66%) and thrombocytopenia (n = 9, 24%); grade 3–4 non-hematologic toxicity was diarrhea (n = 3, 8%) and mucositis (n = 2, 5%). Two patients (5%) died for intestinal infarction and perforation possibly related to treatment. Conclusions Compliance to the chemo-radiotherapy was very poor. The response rate was lower than that reported in clinical trials, whereas overall survival was comparable. The alternating chemo-radiotherapy is a very complex treatment that cannot be easily applied in clinical practice; a careful selection of patients is mandatory not only considering oncologic and medical criteria, but also the level of awareness of the patient and his family.

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