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  • Measure Summary
  • NQMC:010935
  • Feb 2016

Oral cavity squamous cell carcinoma: percentage of patients who undergo elective neck dissection (END) for clinically node-negative oral cavity squamous cell carcinoma for whom at least 18 lymph nodes are resected and pathologically examined.

Nussenbaum B. National Quality Measures Clearinghouse measure submission form: percentage of patients who undergo elective neck dissection (END) for clinically node-negative oral cavity squamous cell carcinoma for whom at least 18 lymph nodes are resected and pathologically examined. St. Louis (MO): Washington University School of Medicine; 2016 Feb 11. 11 p. [9 references]

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2017.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients who undergo elective neck dissection (END) for clinically node-negative oral cavity squamous cell carcinoma for whom at least 18 lymph nodes are resected and pathologically examined.

Rationale

Head and neck cancer is the sixth most common cancer worldwide and is responsible for 5% to 10% of all new cancer cases annually in the United States. It is a disease associated with significant mortality and results in more than 350,000 deaths annually.

There is a growing national imperative to improve the quality of cancer care. Recommendation number three from the Institute of Medicine, in its 10 Recommendations for Improving the Quality of Cancer Care in America, is to measure and monitor the quality of care using a core set of quality measures. A call for the development of quality measures for patients with oral cavity squamous cell carcinoma (OCSCC) was approved by the executive council of the American Head and Neck Society (AHNS) in 2007. Nationally endorsed and validated quality measures for patients with OCSCC do not yet exist. To improve the quality of oral cavity cancer care, reliable and valid measures of health care quality must be developed.

These indicators can be used to assess the quality of care delivered to patients with oral cavity squamous cell carcinoma. By providing for a consistent approach to measuring quality (same indicators, same definitions, same data elements) these measures would allow institutions to have reliable performance data to benchmark current performance levels, identify areas for improvement, evaluate the effects of quality improvement projects, and provide comparisons across centers.

The indicator is intended to monitor the percentage of patients who undergo elective neck dissection (END) for clinically node-negative oral cavity squamous cell carcinoma for whom at least 18 lymph nodes are resected and pathologically examined.

Evidence for Rationale

Chen AY. The development of quality of care measures for oral cavity cancer. Arch Otolaryngol Head Neck Surg. 2008 Jun;134(6):672. PubMed External Web Site Policy

Ebrahimi A, Clark JR, Amit M, Yen TC, Liao CT, Kowalski LP, Kreppel M, Cernea CR, Bachar G, Villaret AB, Fliss D, Fridman E, Robbins KT, Shah JP, Patel SG, Gil Z. Minimum nodal yield in oral squamous cell carcinoma: defining the standard of care in a multicenter international pooled validation study. Ann Surg Oncol. 2014 Sep;21(9):3049-55. PubMed External Web Site Policy

Gourin CG, Couch ME. Defining quality in the era of health care reform. JAMA Otolaryngol Head Neck Surg. 2014 Nov;140(11):997-8. PubMed External Web Site Policy

Hessel AC, Moreno MA, Hanna EY, Roberts DB, Lewin JS, El-Naggar AK, Rosenthal DI, Weber RS. Compliance with quality assurance measures in patients treated for early oral tongue cancer. Cancer. 2010 Jul 15;116(14):3408-16. PubMed External Web Site Policy

Jaber JJ, Zender CA, Mehta V, Davis K, Ferris RL, Lavertu P, Rezaee R, Feustel PJ, Johnson JT. Multi-institutional investigation of the prognostic value of lymph node yield in advanced-stage oral cavity squamous cell carcinoma. Head Neck. 2014 Oct;36(10):1446-52. PubMed External Web Site Policy

Nussenbaum B. National Quality Measures Clearinghouse measure submission form: percentage of patients who undergo elective neck dissection (END) for clinically node-negative oral cavity squamous cell carcinoma for whom at least 18 lymph nodes are resected and pathologically examined. St. Louis (MO): Washington University School of Medicine; 2016 Feb 11. 11 p. [9 references]

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108. PubMed External Web Site Policy

Shah JL, Kaplan M, Divi V, Le Q, Hara W. Effect of the extent of lymph node dissection on overall survival in patients treated for oral cavity squamous cell carcinoma. J Clin Oncol. 2015;33(suppl; abstr 6075)

Weber RS, Lewis CM, Eastman SD, Hanna EY, Akiwumi O, Hessel AC, Lai SY, Kian L, Kupferman ME, Roberts DB. Quality and performance indicators in an academic department of head and neck surgery. Arch Otolaryngol Head Neck Surg. 2010 Dec;136(12):1212-8. PubMed External Web Site Policy

Primary Health Components

Oral cavity squamous cell carcinoma; elective neck dissection; resection and pathological examination of regional lymph nodes

Denominator Description

Number of patients who undergo elective neck dissection(s) (i.e., staged as clinically N0 based on physical exam and imaging), for oral cavity squamous cell carcinoma (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients who undergo elective neck dissection(s) (i.e., was staged as clinically N0 based on physical exam and imaging), for oral cavity squamous cell carcinoma for whom at least 18 lymph nodes are resected and pathologically examined (or 36 lymph nodes if bilateral neck dissections are performed) (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Quality indicators were identified from available literature, consensus guidelines, and head and neck cancer experts. Adherence with individual quality measures and a composite measure of all indicators was assessed via retrospective chart review on 192 patients with previously untreated oral cavity squamous cell carcinoma who underwent surgery at a tertiary care academic medical center between 2003 and 2010. Of the 19 proposed measures, 4 maintained a robust correlation between performance of the measure and improved survival on univariable and multivariable analysis.

Refer to Association of Compliance with Process-related Quality Metrics and Improved Survival in Oral Cavity Squamous Cell Carcinoma for additional measure testing information.

Evidence for Extent of Measure Testing

Graboyes EM, Gross J, Kallogjeri D, Piccirillo JF, Al-Gilani M, Stadler ME, Nussenbaum B. Association of compliance with process-related quality metrics and improved survival in oral cavity squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg. 2016 May 1;142(5):430-7. [34 references] PubMed External Web Site Policy

Nussenbaum B. National Quality Measures Clearinghouse measure submission form: percentage of patients who undergo elective neck dissection (END) for clinically node-negative oral cavity squamous cell carcinoma for whom at least 18 lymph nodes are resected and pathologically examined. St. Louis (MO): Washington University School of Medicine; 2016 Feb 11. 11 p. [9 references]

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients greater than or equal to 18 years of age undergoing elective neck dissection as part of definitive surgical management of oral cavity squamous cell carcinoma

Exclusions

  • Staged as clinically N positive
  • Do not undergo a neck dissection
  • Undergo sentinel lymph node biopsy without completion neck dissection
  • Previous treatment of oral cavity cancer
  • Prior history of head and neck cancer
  • Histology other than squamous cell carcinoma (or its histologic subtypes)
  • Management strategy other than up-front definitive intent surgery +/- postoperative adjuvant therapy

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of patients who undergo elective neck dissection(s) (i.e., was staged as clinically N0 based on physical exam and imaging), for oral cavity squamous cell carcinoma for whom at least 18 lymph nodes are resected and pathologically examined (or 36 lymph nodes if bilateral neck dissections are performed)

Note: If a patient underwent a sentinel lymph node biopsy (SLNB) followed by completion lymphadenectomy, the sum of the lymph nodes from the SLNB and completion lymphadenectomy was used to determine compliance with the metric relative to the 18 cut point).

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Registry data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Percentage of patients who undergo elective neck dissection (END) for clinically node-negative oral cavity squamous cell carcinoma for whom at least 18 lymph nodes are resected and pathologically examined.

Measure Collection Name

Oral Cavity Squamous Cell Carcinoma

Submitter

Washington University School of Medicine - Academic Institution

Developer

Washington University School of Medicine - Academic Institution

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

  • Brian Nussenbaum, MD
  • Evan M. Graboyes, MD
  • Dorina Kallogjeri, MD
  • Jay F. Piccirillo, MD
  • Michael E. Stadler, MD
  • Jennifer Gross, MD
  • Maha al-Gilani, MD

Financial Disclosures/Other Potential Conflicts of Interest

No relevant disclosures of conflicts of interest

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Feb

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2017.

Source(s)

Nussenbaum B. National Quality Measures Clearinghouse measure submission form: percentage of patients who undergo elective neck dissection (END) for clinically node-negative oral cavity squamous cell carcinoma for whom at least 18 lymph nodes are resected and pathologically examined. St. Louis (MO): Washington University School of Medicine; 2016 Feb 11. 11 p. [9 references]

Measure Availability

Source not available electronically.

For more information, contact Brian Nussenbaum, MD, at the Washington University School of Medicine, Department of Otolaryngology–Head and Neck Surgery, 600 S. Euclid Avenue, Campus Box 8115, St. Louis, MO 63110; Phone: 314-362-6599; Fax: 314-362-7522; Email: nussenbaumb@ent.wustl.edu.

NQMC Status

This NQMC summary was completed by ECRI Institute on September 12, 2016. The information was verified by the measure developer on September 13, 2016.

The information was reaffirmed by the measure developer on January 17, 2017.

Copyright Statement

No copyright restrictions apply.

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