A study of older patients with advanced head and neck cancers has found that where they were treated significantly influenced their survival (Cancer, March 1, 2013).
To conduct the study, Dr. Eduardo MĂ©ndez and colleagues from Fred Hutchinson Cancer Research Center used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 1,195 patients ages 66 and older who were diagnosed with advanced head and neck squamous cell carcinomas (HNSCCs) between 2003 and 2007. Treatment modalities and survival were determined using Medicare data; hospital volume was determined by the number of patients with HNSCC treated at each hospital.
Patients who were treated at hospitals that saw a greater number of head and neck cancers were 15% less likely to die of their disease, compared with patients who were treated at hospitals that saw a relatively low number of such cancers, according to the researchers. The study also showed that patients were 12% less likely to die of their disease when treated at a National Cancer Institute (NCI)-designated cancer center.
MĂ©ndez and colleagues also hypothesized that patients with HNSCC who were treated at high-volume hospitals would be more likely to receive therapy that complies with National Comprehensive Cancer Network (NCCN) guidelines, due to the complexity of managing these cancers. Surprisingly, this was not the case, the researchers found.
NCCN guidelines recommend multimodality therapy for almost all advanced cases. Despite the improved survival at high-volume hospitals, the proportion of patients who received multimodality therapy was similar -- 78% and 79% -- at low- and high-volume hospitals, respectively.
"Although this study does not necessarily mean that all patients with advanced HNSCC should be treated at high-volume hospitals or at NCI-designated cancer centers, it does suggest that features of these hospitals, such as a multidisciplinary team approach or other institutional factors, play a critical role in influencing survival without influencing whether patients receive NCCN-guideline therapy," the authors concluded.
