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

Abstract

Objective To analyze the clinicodemographic characteristics and treatment outcomes of patients receiving postoperative radiation therapy (PORT) at a different treatment facility rather than the initial surgical facility for head and neck cancer. Study Design: Retrospective cohort analysis. Methods Utilizing the National Cancer Data Base, 2004 to 2015, patients with a diagnosis of oral cavity/oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma were studied. Multivariate analysis was completed with multivariate regression and Cox proportional hazard model, and survival outcomes were examined using Kaplan‐Meier analysis. Results A total of 15,181 patients who had surgery for a head and neck cancer at an academic/research center were included in the study population. Of the study population, 4,890 (32.2%) patients completed PORT at a different treatment facility. Treatment at a different facility was more common among patients who were ≥65 years old, white, Medicare recipients, those with a greater distance between residence and surgical treatment facility, and with lower income within area of residence (each P < .05). Overall survival was worse in patients completing PORT at a different treatment facility versus at the institution where surgery was completed (61.9% vs. 66.4%; P = .002). Conclusions PORT at a different facility was more common in older individuals, Medicare recipients, those with greater distance to travel, and lower‐income individuals. Completing PORT outside the hospital where surgery was performed was associated with inferior survival outcomes among head and neck cancer patients. Level of Evidence 3 Laryngoscope, 131:1019–1025, 2021

Factors associated with postoperative radiotherapy at a different facility in sinonasal squamous cell carcinoma

“…Kaplan‐Meier analyses showed that patients undergoing PORT at a different facility for SNSCC did not have significantly different OS compared with patients undergoing PORT at the same facility. This is in contrast to previous studies of NSN‐HNC patients, which showed significantly lower survival for those undergoing PORT at a different facility 3,8 . There are potential barriers in communication between providers at different facilities treating HNC patients, but the integration of electronic medical records systems has been shown to decrease the fragmentation of care 9,10 …”

“…This is in contrast to previous studies of NSN-HNC patients, which showed significantly lower survival for those undergoing PORT at a different facility. 3,8 There are potential barriers in communication between providers at different facilities treating HNC patients, but the integration of electronic medical records systems has been shown to decrease the fragmentation of care. Limitations of this study include miscoding of entries in the NCDB and the lack of details with regard to recurrence, treatment-specific outcomes, disease-specific survival, facility reputation, and patient traveling constraints.…”

“…Sullivan et al found that completing PORT outside the facility where surgery was performed for non-sinonasal head and neck cancer (NSN-HNC) was associated with inferior survival. 3 In our study, we sought to determine factors associated with delivery of PORT at a different facility from the location of surgery for SNSCC patients, and the impact of PORT facility on survival.…”

Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy

“…Although not explicitly applying the social-ecological framework, prior studies have considered individual-level factors and added a level to the framework, with organization-level factors increasing risk of PORT delay. Specifically, authors include payers, separate surgical and PORT facilities, postoperative length of stay, advanced stage at presentation, and tumor site . Contrary to these prior investigations, the current study assessed the individual- and community-level influences on delays and found that a predictive model incorporating multiple levels of influence from the social-ecological framework outperformed a model based on individual-level factors alone.…”

Factors Associated With a Prolonged Diagnosis‐to‐Treatment Interval in Laryngeal Squamous Cell Carcinoma

“…Demographic factors such as race, ethnicity, sex, and insurance status have previously been implicated in LSCC incidence and management disparities. 10,39,[46][47][48][49] Non-White race has been shown to be an independent risk factor for laryngeal cancer prognosis regardless of age, sex, tumor size, and nodal invasion, demonstrating a reduced 5-year survival rate in Hispanic and Black populations as compared with White populations (59.5%, 52.7%, and 60.6%, respectively). 10 Lebo et al 50 reported that insurance, Black race, female sex, and older age are associated with LSCC severity at presentation, with lack of insurance being the strongest predictor.…”