Where a patient is treated affects cancer survival
A study of older patients with advanced head and neck cancers has found that where they were treated significantly influenced their survival. The study found that patients who were treated at hospitals that saw a high number of head and neck cancers were 15% less likely to die of their disease as compared to patients who were treated at hospitals that saw a relatively low number of such cancers. The study also found that such patients were 12% less likely to die of their disease when treated at a National Cancer Institute-designated cancer center.
According to an American Cancer Society estimate, 52,610 new cases of head and neck cancer were diagnosed in Americans in 2012. Many diagnoses are locally advanced disease that has spread to the lymph nodes, which carry a much poorer prognosis compared to early stage disease. Patients with advanced disease require multidisciplinary management by a collaborative team comprised of multiple physician specialties and disciplines. National Comprehensive Cancer Network (NCCN) guidelines, based on data from randomized controlled trials, recommend multimodality therapy (either surgery followed by adjuvant therapy or primary chemoradiation) for almost all advanced cases.
"Where you're treated matters," said corresponding author Eduardo Méndez, MD, an assistant member of the Clinical Research Division at Fred Hutchinson Cancer Research Center in Seattle, Washington. This study was published in Cancer (2013; doi:10.1002/cncr.27976).
Méndez and colleagues also hypothesized that patients with head and neck squamous cell carcinomas (HNSCCs) who were treated at high-volume hospitals would be more likely to receive therapy that complies with NCCN guidelines due to the complexity of managing these cancers. Surprisingly, this was not the case, the researchers found.
The study found that despite the improved survival at high-volume hospitals, the proportion of patients who received multimodality therapy was similar, as it was received by 78% of patients at low-volume hospitals and 79% at high-volume hospitals.
"NCCN guidelines are well publicized in the medical community and it was exciting to learn that clinicians at both high- and low-volume hospitals are implementing these guidelines into the complex clinical management of patients with head and neck cancer," said Méndez, who is an expert in the surgical treatment of head and neck cancer and an associate professor of otolaryngology—head and neck surgery at the University of Washington School of Medicine.
"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.
The implementation of NCCN-guideline therapy can be challenging because there are toxicities associated with these treatments that require a high level of support and infrastructure, such as that found at comprehensive cancer centers, according to Méndez.