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Accredited hospitals vary in quality of head, neck cancer care
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Pervasive variations exist in the quality of head and neck cancer care across Commission on Cancer hospitals, according to a research letter published in JAMA Otolaryngology- Head & Neck Cancer.
The American College of Surgeons’ Commission on Cancer was established with a goal of improving patient quality of life by forming professional standards, benchmarks and metrics for the treatment of cancer in the United States.
“Although variation of quality of care has been studied elsewhere, variation of these
quality metrics has not been examined in depth,” William A. Strober, BA, medical student at University of Pittsburgh School of Medicine, and colleagues wrote. “Commission on Cancer hospitals, which have been accredited based on several benchmarks for comprehensive, high-quality cancer care, treat approximately 70% of patients with head and neck cancer in the United States. Therefore, variation among these centers may identify opportunities for improvement that could be addressed through existing quality improvement programs.”
Strober and colleagues reviewed the National Cancer Database to identify 72,322 patients aged 18 years and older (mean age, 60.9 years; standard deviation [SD], 12.5; 69.8% men) with surgically treated, invasive, nonmetastatic squamous cell carcinoma of the oral cavity, oropharynx, larynx and hypopharynx. Eligible participants underwent treatment between 2004 and 2014 at one of 770 hospitals.
Researchers evaluated five quality metrics: negative surgical margins; neck dissection lymph node count of 18 or more; suitable adjuvant radiotherapy for T3-T4 or N2-N3 disease; suitable chemoradiotherapy for positive margins or extension outside the node; and adjuvant treatment within 6 weeks. They compared overall quality based on the hospital volume and safety-net burden.
Mean overall quality score of all hospitals was 69.2% (SD, 30.4%). However, scores varied widely among low- (range, 48%-89%), intermediate- (range, 45%-90%) and high- (range, 52%-82%) volume hospitals.
The researchers also observed this variation among different types of hospitals, including academic (range, 48%-82%), integrated (range, 54%-80%), community (range, 48%-89%) and comprehensive (range, 45%-90%) cancer facilities.
Similarly, wide differences occurred across the highest (range, 45%-84%), second highest (range, 44%-82%), third highest (range, 45%-85%) and lowest (range, 51%-90%) quartiles of hospital safety-net burden.
The researchers suggested a strategy to address these disparities.
“Given challenges with travel and insurance that many patients face, centralizing all care of head and neck cancer at high-volume facilities with a low safety-net burden is not feasible,” the researchers wrote. “Instead, we should identify centers of excellence that consistently achieve high-quality care so that these lessons can be shared.” – by Jennifer Byrne
Disclosures : Strober reports no relevant disclosures. One author reports personal fees from Medtronic and grants from Kolltan Pharmaceuticals outside the submitted work.
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