Regional guideline for diagnosis and treatment of squamous cell carcinoma of the lip:what is the lever of compliance?

Objective. To investigate to what extent physicians comply with a regional guideline for the diagnosis, staging, treatment and follow-up of patients with squamous cell carcinoma of the lower lip. Design. Retrospective analysis of data from the medical records of 248 patients diagnosed with squamous cell carcinoma of the lower lip during the period 1989-1997. Setting. Comprehensive Cancer Centre of the Northern region of the Netherlands. Study participants. The data were collected by this Centre for the regional population-based cancer registry. Results. Overall compliance with the separate guidelines varied between 4 and 80%. For diagnosis and staging, the guideline was followed for 4-70% of patients. The type of treatment in relation to age conformed to the guideline in 34% of cases. Of the 208 surgically-treated patients, treatment was performed in accordance with the guidelines in 92 (44%) patients, compared with seven out of 18 (39%) patients who received radiotherapy. Follow-up in accordance with the guideline was 11% in the first year, 9% in the second year and 21% in the third year. Conclusion. Only a minority of patients with squamous cell carcinoma of the lower lip, a rare tumour, were managed according to the available regional guideline. Regular review of both the guideline and its implementation is necessary in order to optimize its use