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 w ith squamous cell carcinoma of the lower lip. Design. Retrospective analysis of data from the medical records of 248 pati ents diagnosed with squamous cell carcinoma of the lower lip during the per iod 1989-1997. Setting. Comprehensive Cancer Centre of the Northern region of the Netherla nds. 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 a nd 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 guideli ne in 34% of cases. Of the 208 surgically-treated patients, treatment was p erformed in accordance with the guidelines in 92 (44%) patients, compared w ith 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 y ear 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.