Facility type linked to ‘significant differences’ in survival for head/neck cancer
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Key takeaways:
- The proportion of patients receiving care at community cancer centers has increased since 2010.
- Patients at community cancer centers more likely received nonsurgical treatment.
The increased treatment of patients with HPV-related oropharyngeal squamous cell carcinoma at community cancer centers is linked to poorer survival outcomes, according to data published in Journal of the National Cancer Institute.
The majority of patients with such a cancer type are treated at an academic cancer center; however, the proportion of patients treated at community cancer centers is estimated to have risen by 10% from 2010 to 2019, researchers wrote.
“The site of care determines patient outcomes and may influence the therapy landscape and survival for these rare head and neck cancer patients in the future,” Carole Fakhry, MD, MPH, director of Johns Hopskins Head and Neck Cancer Center, said in a press release.
Background and methodology
Some studies have shown lower OS for patients with head and neck cancer who received treatment at low-volume or community cancer centers. The researchers conducted a cohort study of patients from the U.S. National Cancer Database on the hypothesis that as the incidence of HPV-related oropharyngeal squamous cell carcinoma rises in the United States, a greater proportion of patients will be treated at community cancer centers, with an increase toward primary nonsurgical treatment being noticeable.
Patients in the study received a diagnosis of HPV-related oropharyngeal squamous cell carcinoma between 2010 and 2019 and underwent treatment at a community cancer center or academic cancer center.
Researchers analyzed the proportion of patients with HPV-related oropharyngeal squamous cell carcinoma treated at community cancer centers who received nonsurgical treatment, comparing 4-year OS between community cancer centers and academic cancer centers.
Results, next steps
Although more than two-thirds of patients (n = 20,298; 67.4%) received treatment at academic cancer centers, the proportion of patients who received treatment at community cancer centers increased by 10% from 2010 to 2019.
Additionally, the proportion of patients who underwent primary nonsurgical treatment increased from 62.1% to 73.7% over the same period, with patients being significantly more likely to undergo nonsurgical treatment at community cancer centers vs. academic cancer centers (adjusted OR = 1.2; 95% CI, 1.18-1.22).
Researchers noted an association between treatment at community cancer centers and worse survival outcomes (adjusted HR = 1.19; 95% CI, 1.09-1.31), most notably among patients receiving primary nonsurgical treatment (adjusted HR = 1.22; 95% CI, 1.11-1.34).
The increase in the proportion of patients receiving care at community cancer centers correlated with an increase in nonsurgical treatment and a decrease in survival odds, according to researchers, meaning that efforts should be made to direct more patients to academic cancer centers.
“This analysis revealed clinically and statistically significant differences in the type and quality of care provided by community and academic cancer centers in the United States, with progression of these trends over time,” Fakhry and colleagues wrote. “Although in 2010 only one-quarter of patients in the United States with HPV-related oropharyngeal squamous cell carcinoma received cancer treatment at community cancer centers, by 2019, this number had increased to more than one-third.”
References
- Community cancer care linked with poorer outcomes for some head/neck cancers (press release). Available at: https://www.hopkinsmedicine.org/news/newsroom/news-releases/2024/01/community-cancer-care-linked-with-poorer-outcomes-for-some-headneck-cancers. Published Jan. 3, 2024. Accessed Jan. 24, 2024.
- Trakimas DR, et al. J Natl Cancer Inst. 2024;doi:10.1093/jcni/djad238
Perspective
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Ted Okon, MBA
The reporting of the results of this study is significantly flawed and leads to highly misleading conclusions.
The authors report on the findings of “academic cancer centers” vs. “community cancer centers,” but in both cases these are all hospitals, not independent, physician-run cancer clinics. The results should have been reported as “academic hospital cancer canters” vs. “community hospital cancer centers.” The database used — the National Cancer Database — “is a clinical oncology database sourced from hospital registry data collected in more than 1,500 Commission on Cancer-accredited facilities.”
More than 50% of cancer care in the U.S. is delivered by independent oncology practices located in communities across the country; the remainder is delivered by hospital facilities. These independent community oncology practices range in size from 400+ providers to smaller practices, all delivering high-quality and high-value care. There is clear evidence that independent community oncology is more accessible and affordable for most Americans.
The academic-center authors of this study do patients with cancer a huge disservice by putting out this poorly reported research that serves to sow fear, doubt and confusion among patients who now may question the quality of care they are receiving in independent community cancer clinics.
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