Association of Type of Treatment Facility With Overall Survival After a Diagnosis of Head and Neck Cancer

Abstract

IMPORTANCE Patients with head and neck cancer receive care at academic comprehensive cancer programs (ACCPs), integrated network cancer programs (INCPs), comprehensive community cancer programs (CCCPs), and community cancer programs (CCPs). The type of treatment facility may be associated with overall survival.OBJECTIVE To examine whether type of treatment facility is associated with overall survival after a diagnosis of head and neck cancer. DESIGN, SETTING, AND PARTICIPANTSThis population-based retrospective cohort study included patients from the National Cancer Database, a prospectively maintained, hospital-based cancer registry of patients treated at more than 1500 US hospitals. Participants were diagnosed with malignant tumors of the EXPOSURES Treatment at facilities classified as ACCPs, INCPs, CCCPs, or CCPs. MAIN OUTCOMES AND MEASURES Overall survival after diagnosis and treatment of head and neck cancer was the primary outcome. The secondary outcome was the odds of receiving treatment at ACCPs and INCPs vs CCCPs and CCPs. Multivariable Cox proportional hazards regression and univariable and multivariable logistic regression models were used for analysis. RESULTS A total of 525 740 patients (368 821 men [70.2%]; mean [SD] age, 63.3 [14.0] years) were diagnosed with malignant tumors of the head and neck during the study period. Among them, 36 595 patients (7.0%) were treated at CCPs; 174 658 (33.2%), at CCCPs; 232 867 (44.3%), at ACCPs; and 57 857 (11.0%), at INCPs. The median survival for patients with aerodigestive cancers was 69.2 (95% CI, 68.6-69.8) months; salivary gland cancers, 107.2 (95% CI, 103.9-110.2) months; and skin cancers, 113.2 (95% CI, 111.4-114.6) months. Improved overall survival was associated with treatment at ACCPs (hazard ratio [HR], 0.89; 95% CI, 0.88-0.91), INCPs (HR, 0.94; 95% CI, 0.92-0.96), and CCCPs (HR, 0.94; 95% CI, 0.92-0.95) compared with CCPs. Compared with patients with private insurance, those with government insurance (odds ratio [OR], 1.35; 95% CI, 1.29-1.41), no insurance (OR, 1.12; 95% CI, 1.09-1.16), or Medicaid (OR, 1.17; 95% CI, 1.14-1.20) were more likely to receive treatment at ACCPs and INCPs, whereas patients with Medicare were less likely to receive treatment at ACCPs and INCPs (OR, 0.95; 95% CI, 0.94-0.97). Compared with white patients, black (OR, 1.55; 95% CI, 1.52-1.59) and Asian (OR, 1.56; 95% CI, 1.49-1.63) patients were more likely to receive care at ACCPs and INCPs. Compared with patients from lower-income areas, patients from high-incomeareas were more likely to receive treatment at ACCPs and INCPs (OR, 1.25; 95% CI, 1.22-1.28). (continued)

The Association of Treatment Facility Type With the Survival of Brain Metastases Patients Regardless of the Primary Site Cancer

“…The results of the current study are consistent with the ndings of other studies in various cancers [25][26][27][28] .…”

“…Treatment at academic hospitals was associated with Improved overall survival with a hazard ratio (HR: 0.89, CI: 0.88-0.91) compared to community center programs in a study of head and neck cancer patients who received surgery. In this study, patients with Medicaid and patients from low-income areas were less likely to receive treatment at academic centers 25 . Few studies of the Glioblastoma patients who underwent surgery reported improved OS for patients treated at academic centers compared to community treatment centers [26][27][28] .…”

“…Further, a study of glioblastoma patients who received surgery reported improved OS (HR: 1.07, CI: 1.05 1.09, and 1.13, CI: 1.10 1.15) for academic compared to Comprehensive Community Cancer programs and Integrated Network Cancer programs28 . Head and neck cancer patients with the surgical resection of the tumor who received treatment at academic hospitals had better OS compared to patients treated at community hospitals (HR: 0.89, CI: 0.88-0.91)25 .Patients with BMs are different from primary brain tumors and patients of head and neck cancers. The pathophysiology, prevalence, and treatment approaches vary signi cantly.…”

Factors Associated With the Choice of Radiation Therapy Treatment Facility in Head and Neck Cancer

“…The present study demonstrates that OS is worse when performed at a different facility. A recently published analysis of NCDB patients with aerodigestive tract, salivary gland, or head and neck melanoma showed improved overall survival when treatment was completed at an academic medical center compared to community cancer programs 17 . That report did not address the possibility that multidisciplinary treatment took place at more than once facility.…”

The impact of treatment facility type on the survival of brain metastases patients regardless of the primary cancer type

“…Treatment at academic hospitals was associated with Improved overall survival with a hazard ratio (HR: 0.89, CI: 0.88–0.91) compared to community center programs in a study of head and neck cancer patients who received surgery. In this study, patients with Medicaid and patients from low-income areas were less likely to receive treatment at academic centers [ 25 ]. Few studies of the Glioblastoma patients who underwent surgery reported improved OS for patients treated at academic centers compared to community treatment centers [ 26 – 28 ].…”