Oral cancer patients achieve comparable survival at high safety-net burden hospitals

Lam, Christa M.; Qureshi, Muhammad M.; Patel, Prachi; Park, Justin J.; Dang, Rushil R.; Rubin, Samuel J.; Salama, Andrew; Truong, Minh Tam

doi:10.1016/j.amjoto.2022.103438

Cited by 2 publications

(9 citation statements)

References 29 publications

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“…Consistent with the present findings, higher safetynet burden status has also been associated with delayed time to treatment, similar or increased hospital LOS, and similar rates of surgical readmissions. [9][10][11]13,14,16,19 With regards to overall survival, previous studies have conflicted, demonstrating no difference for patients with sinonasal and oral cavity tumors, 11,15 but inferior overall survival for patients with laryngeal tumors treated at HBH. 14 Notably, many of these studies either did not include patients with OPSCC, or pooled all patients with head and neck cancer, which is a heterogenous population.…”

Section: Discussionmentioning

confidence: 99%

“…With regards to overall survival, previous studies have conflicted, demonstrating no difference for patients with sinonasal and oral cavity tumors, 11,15 but inferior overall survival for patients with laryngeal tumors treated at HBH 14 . Notably, many of these studies either did not include patients with OPSCC, or pooled all patients with head and neck cancer, which is a heterogenous population 9–16 . Several studies also evaluated single institution samples and had varied definitions of safety‐net burden 9,12,13,16 .…”

Section: Discussionmentioning

confidence: 99%

“…Given the above considerations, we speculate that there may be intrinsic factors of higher safety‐net burden facilities that contribute to the differences in treatment patterns and outcomes seen in the present study. For example, the greater demand placed on the few highly specialized surgeons to perform the complex procedures required to treat OPSCC at higher burden facilities, as well as more advanced tumor presentations, 11,14 may contribute to the increased use of radiation over surgery. In addition, the need for advanced equipment and unique skillset required to perform TORS may lead to its less frequent use 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Treatment facilities included in this study were evaluated for safety-net burden (i.e., the proportion of uninsured or Medicaid-insured patients treated at the facility) based on previously described methods. 11,14,15 Safety-net burden was defined as the average number of uninsured and Medicaid-insured patients treated for OPSCC per year. Facility volume was defined as the average number of patients with OPSCC treated per year.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4][5] Given the importance of insurance status on outcomes at the individual patient level, 1,2,[6][7][8] previous literature has attempted to expand this relationship to the facility level by evaluating a hospital's safety-net burden status. [9][10][11][12][13][14][15][16] High safety-net burden hospitals are defined as those that "organize and deliver a significant level of health care and other health-related services to uninsured, Medicaid, and other vulnerable patients". 17 In addition to treating more patients with low socioeconomic status, high safety-net burden hospitals have been shown to treat more patients with advanced stage head and neck cancer and have been associated with increased time to treatment, more urgent or emergent admissions, longer hospital length of stay (LOS), decreased follow-up, and lower overall survival compared to lower safety-net burden hospitals.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Hospital Safety‐Net Burden Status on Patients with HPV‐Positive Oropharyngeal Cancer

Gilja,

Kumar,

Kapustin

et al. 2023

The Laryngoscope

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ObjectivesThe objective of this study was to compare treatment characteristics and outcomes between patients with HPV‐positive oropharyngeal squamous cell carcinoma (OPSCC) treated at hospitals of varying safety‐net burden status.MethodsPatients with cT1‐4, N0‐3, M0 HPV‐positive OPSCC who underwent definitive surgery or radiation were included. Patients were grouped based on their treating hospital safety‐net burden status, defined as the percentage of uninsured and Medicaid‐insured patients with OPSCC treated at the facility and stratified as low burden (LBH: 0–25th percentile), medium burden (MBH: 25th–75th percentile), or high burden (HBH: 75th–100th percentile). The primary outcome was primary treatment with surgery versus radiation, evaluated with multivariable‐adjusted logistic regression. Secondary outcomes included TORS versus open surgical approach, and overall survival evaluated with Cox proportional hazards analysis.ResultsOf the 19,810 patients with cT1‐4, N0‐3, M0 HPV‐positive OPSCC included in this study, 4921 (24.8%) were treated at LBH, 12,201 (61.6%) were treated at MBH, and 2688 (13.6%) were treated at HBH. In multivariable‐adjusted analysis, compared with treatment at LBH, treatment at HBH was associated with more frequent radiation over surgical treatment (OR: 1.26, 95% CI: 1.12–1.40, p < 0.001). For patients undergoing surgery, patients at HBH had less frequent transoral robotic surgery (OR: 0.30, 95% CI 0.24–0.38, p < 0.001) compared with patients treated at LBH. Overall survival of patients treated at HBH was worse than that of patients treated at LBH (HR: 1.27, 95% CI 1.13–1.43, p < 0.001).ConclusionThese findings highlight underlying disparities at higher safety‐net burden facilities that impact patterns of care and outcomes for patients with OPSCC.Level of Evidence3 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The Impact of Hospital Safety‐Net Burden Status on Patients with HPV‐Positive Oropharyngeal Cancer

Gilja,

Kumar,

Kapustin

et al. 2023

The Laryngoscope

Self Cite

View full text Add to dashboard Cite

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Differences in Surgical Cancer Care Delivery and Outcomes Between Safety‐Net and Non‐Safety‐Net Hospitals in the United States: A Comprehensive Systematic Review

Alsalek,

Liu,

Han

et al. 2024

Journal of Surgical Oncology

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BackgroundStudies evaluating the association of safety‐net hospitals (SNHs) with outcomes of surgical care in cancer patients have demonstrated mixed results. We sought to systematically investigate the association of SNH status with measures of surgical cancer care delivery and outcomes.MethodsA comprehensive review of the literature identified from the MEDLINE/PubMed, Embase, Web of Science, and Cochrane databases was performed according to the PRISMA guidelines. Risk of bias assessment was conducted using the Joanna Briggs Institute's tool. The findings were synthesized qualitatively.ResultsOf the 1749 records identified, 33 retrospective studies were included, 79% of which investigated national databases. Risk of bias assessment revealed average score of 78%. Among studies assessing each outcome, lower likelihood of receiving appropriate surgical interventions in SNH patients was reported by 85%; longer intervals to surgery by 100%; and prolonged hospital stays by 73%. Most studies reported no differences in survival (65%) or readmission (67%). Results were mixed regarding complications and mortality. Patient characteristics and shortage of resources and interdisciplinary teams were frequently proposed factors for observed disparities.ConclusionsCancer patients at SNHs may be less likely to undergo some surgical treatments and experience longer intervals to treatment but achieve largely comparable short‐ and long‐term outcomes to non‐SNH patients.

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Oral cancer patients achieve comparable survival at high safety-net burden hospitals

Cited by 2 publications

References 29 publications

The Impact of Hospital Safety‐Net Burden Status on Patients with HPV‐Positive Oropharyngeal Cancer

The Impact of Hospital Safety‐Net Burden Status on Patients with HPV‐Positive Oropharyngeal Cancer

Differences in Surgical Cancer Care Delivery and Outcomes Between Safety‐Net and Non‐Safety‐Net Hospitals in the United States: A Comprehensive Systematic Review

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