Treatment at high‐volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer

David, John; Ho, Allen S.; Luu, Michael; Yoshida, Emi; Kim, Sungjin; Mita, Alain C.; Scher, Kevin S.; Shiao, Stephen L.; Tighiouart, Mourad; Zumsteg, Zachary S.

doi:10.1002/cncr.30843

Cited by 127 publications

(150 citation statements)

References 42 publications

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“…Whereas prior literature has forecasted an epidemic, this analysis highlights that non-oropharyngeal HNSCCs are becoming increasingly rare in the US and OPSCC remain rare. This in combination with the extensive data regarding survival benefits for high-volume centers 17–19 support the need for centralized care of HNSCC patients.…”

Section: Discussionmentioning

confidence: 76%

Head and neck squamous cell cancers in the United States are rare and the risk now is higher among white individuals compared with black individuals

Fakhry

Krapcho

Eisele

et al. 2018

Cancer

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Background The increasing incidence of oropharynx squamous cell cancer (OPSCC) is well established. However, up-to date incidence estimates and trends for head and neck squamous cell cancers (HNSCC) overall including major anatomic sites and non-oropharyngeal (non-OP) HNSCCs by sex, race and age in the United States (US) are not well described. Methods Retrospective analysis of incident HNSCCs during 1992-2014 using Surveillance, Epidemiology, and End Results (SEER) database was used to evaluate incidence of HNSCCs overall, OPSCC and non-OP HNSCC (larynx, oral cavity, hypopharynx, nasopharynx, nasal cavity). Incidence rates were calculated overall and by subgroups of interest, and incidence rate ratios (IRR) were used to compare rates between groups. The incidence rates presented are per 100,000 people and age-adjusted to the 2000 US Standard Population (19 age groups – Census P25-1130). Annual percent change (APC) was modeled with and without joinpoints Results Incidence of HNSCC overall declined (average APC [aAPC] -0.8, p<0.001) in spite of significant increases in incidence of OPSCCs, most notably between 2000-2014 (APC=2.1, p<0.001). Indeed, significant declines in incidence were observed for all non-OP HNSCC sites, for both women and men (each p<0.001). Among women, risk of OPSCC also significantly decreased (aAPC -0.8, p=0.002), while among men OPSCC risk was stable during 1992-2001 (APC 0.4, p=0.42), then significantly increased during 2001-2014 (APC 2.7, p<0.001). Decreases in non-OP HNSCC risk were especially large for Black women (aAPC -2.6, p<0.001) and men (aAPC -3.0, p<0.001). While incidence of HNSCC used to be highest among Blacks, since 2009 HNSCC incidence is higher among Whites than Blacks. Conclusions Incidence of HNSCC is declining, especially for non-OP HNSCC and Blacks.

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Section: Discussionmentioning

confidence: 76%

Head and neck squamous cell cancers in the United States are rare and the risk now is higher among white individuals compared with black individuals

Fakhry

Krapcho

Eisele

et al. 2018

Cancer

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“…Some studies investigated the association between patient's outcomes and provider/physician volume, 2 institutional clinical trial volume, 3,17 or hospital volume. 7 These data confirm the importance of treatment expertise outside the context of a clinical trial. 21 Recently, an analysis conducted in the United States employing the National Cancer Database showed that patients undergoing curative radiotherapy at high-volume facilities and academic centers showed an increased survival.…”

Section: Discussionmentioning

confidence: 61%

Impact of treatment expertise on the outcome of patients with head and neck cancer treated within 6 randomized trials

et al. 2018

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Background We evaluated the impact of center expertise, in terms of number of patients treated, on the overall survival (OS) and progression‐free survival (PFS) of patients with head and neck squamous cell carcinoma (SCC). Methods We performed a pooled analysis including data from 6 randomized trials in head and neck SCC conducted in Italy. We evaluated the association between OS or PFS and the number of patients recruited by the center. Results The outcome of 903 patients who had received radiotherapy (RT) was analyzed (median follow‐up 76 months). The hazard ratio (HR) comparing the third and the first quartiles of the distribution of number of patients per center showed an advantage in PFS (HR 0.59, range 0.53‐0.65, P < .0001) and in OS (HR 0.70, 0.60‐0.81, P < .0001) for centers with a higher number of patients recruited. A similar benefit was observed in PFS (HR 0.63, 0.60‐0.66) and OS (HR 0.74, 0.69‐0.79) considering the mean number of patients per year. Conclusions The PFS and OS were longer for patients treated in high‐case‐volume centers.

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“…[34][35][36][37] We have previously reported that speech-language pathology care was associated with high-volume care, a reduced odds of dysphagia, and improved survival in elderly patients with OPSCC. The majority of patients in this cohort were nonsmokers with little to no documented comorbidity, 10 which raises the possibility that the majority of these patients had human papillomavirus (HPV)-associated tumors with good performance status and were more resilient to the effects of treatment-related toxicity, and more responsive to process measures associated with higher quality care that address complications of care.…”

Section: Discussionmentioning

confidence: 99%

Quality of care and short and long‐term outcomes of oropharyngeal cancer care in the elderly

et al. 2019

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Objective To examine associations between quality, short‐term and long‐term treatment‐related outcomes, and costs in elderly patients treated for oropharyngeal squamous cell cancer (OPSCC). Methods We retrospectively evaluated Surveillance, Epidemiology, and End Results (SEER)‐Medicare data from 666 patients diagnosed with OPSCC from 2004 to 2007 using multivariate regression and survival analysis. Quality indicators were derived from guidelines for recommended care and performance measures. Results Higher quality care was associated with lower risk of death in patients with dysphagia (hazard ratio [HR] = 0.44 [0.32‐0.60]), weight loss (HR = 0.42 [0.28‐0.62]), gastrostomy (HR = 0.47 [0.33‐0.68]), airway obstruction (HR = 0.41 [0.27‐0.62]), tracheostomy (HR = 0.17 [0.05‐0.67]), and pneumonia (HR = 0.53 [0.33‐0.85]). There were no significant differences in mean incremental costs associated with airway and swallowing impairment for patients receiving higher quality care. Conclusions Higher quality OPSCC care was associated with improved survival in elderly patients with airway and swallowing impairment. These data suggest that greater adherence to evidence‐based guidelines has favorable implications for long‐term outcomes.

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Treatment at high‐volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer

Abstract: Patients with locally advanced head and neck squamous cell carcinoma who are undergoing curative radiotherapy at HVFs and academic centers appear to have improved survival. Cancer 2017;123:3933-42. © 2017 American Cancer Society.

Cited by 127 publications

References 42 publications

Head and neck squamous cell cancers in the United States are rare and the risk now is higher among white individuals compared with black individuals

Head and neck squamous cell cancers in the United States are rare and the risk now is higher among white individuals compared with black individuals

Impact of treatment expertise on the outcome of patients with head and neck cancer treated within 6 randomized trials

Quality of care and short and long‐term outcomes of oropharyngeal cancer care in the elderly

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