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High hospital volume linked to improved survival in patients with advanced disease
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Patients with advanced squamous cell carcinoma of the head and neck who were treated at high-volume hospitals and NCI-designated cancer centers experienced improved survival compared with patients who were treated elsewhere, according to results of a retrospective study.
However, patients treated at high-volume hospitals or NCI-designated centers were not more likely to receive multimodality therapy, study results showed.
Prior studies suggested that patients who underwent major cancer surgery or treatment for laryngeal cancer have improved survival when they are treated at high-volume centers, but the role of hospital volume in other types of advanced SCCHN had not been studied, according to background information provided by researchers.
Also, no studies examined whether hospital characteristics influenced the delivery of multimodality therapy — defined as a combination of surgery, radiotherapy and/or chemotherapy — to that patient population.
Arun Sharma, MD, MS, a resident in otolaryngology at the University of Washington, and colleagues used the SEER database to identify patients with advanced SCCHN — defined as T3, T4, N2 or N3 oral, oropharyngeal, laryngeal or hypopharyngeal carcinomas — who were diagnosed between 2003 and 2005.
Sharma and colleagues used Medicare claims data to evaluate treatment modalities, and they used Medicare data from December 2009 to determine survival. They classified hospitals as high- or low-volume centers based on the number of patients treated for SCCHN.
The researchers evaluated 737 patients, and median follow-up was 29 months.
High hospital volume (HR=0.8; P=.08) and NCI-designated cancer center status (HR=0.77; P=.181) were associated with better survival, according to study results.
Patients treated at high-volume hospitals were more likely to be treated with surgery (OR=1.68; P=.032), according to results of multivariable analyses.
High-volume hospitals were slightly more likely to treat patients with multimodality therapy (77% vs. 73%).
High hospital volume (OR=1.15; P=.588) and NCI-designated cancer center status (OR=1.53; P=.315) were not associated with delivery of multimodality therapy.
“The association of hospital characteristics with survival, but not receipt of multimodality therapy, suggests that features of high-volume and NCI-designated cancer centers besides delivery of multimodality therapy influence survival,” Sharma and colleagues concluded. “[That] could be an area for further investigation.”
For more information:
Sharma A. Abstract #S169. Presented at: the 8th International Conference on Head and Neck Cancer; July 21-25, 2012; Toronto.
Perspective
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Barbara Burtness, MD
It’s been recognized for quite some time that outcomes for complex cancer surgery such as esophagectomy or pancreatic resection are superior at high-volume centers than at hospitals performing fewer of these operations. Given that head and neck cancer surgery and multimodality management are technically demanding, and these cancers are somewhat uncommon, the authors wondered whether treatment for head and neck cancers at higher-volume centers conferred any outcome advantage. They queried the SEER-Medicare database for locally advanced head and neck squamous cancers. The analysis is based on 737 patients who met criteria for inclusion. There was evidence that treatment site did matter: Survival tended to be superior both for patients treated at a high-volume center (HR=0.8) or NCI-designated cancer center (HR=0.77), although given the sample size, this was not statistically significant.
Patients treated at high-volume centers were more likely to have surgery as a component of their management, but the degree to which this contributed to the improved survival cannot be ascertained. These data are certainly compatible with what has been reported for other difficult and less common cancer operations. I’d also be interested to see an analysis of surgical outcomes in patients who did end up with resection. Smaller, more focused studies might be required to answer another question raised by these data, which is whether the increased use of surgery at high-volume centers is associated with better long-term speech and swallowing function.
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