Which Hospitals are Better for Cancer Care?

Head and neck cancer patient outcomes better when treated at high volume and NCI designated hospitals

(RxWiki News) Head and neck cancers include throat, tongue and mouth cancers. These tumors can show up anywhere in the oral cavity. Often detected after the cancer has already begun to spread, head and neck cancer treatment is a complex process. 

According to a recent study, head and neck cancer patients had a 15 percent reduced risk of dying from the cancer when they were treated at hospitals that see a lot of these cancers as opposed to hospitals that treat few oral cancers.

The same study also found that these cancer patients have a 12 percent lower risk of dying if they are treated at a National Cancer Institute-designated cancer center.

"Ask your dentist about oral cancer screening."

Researchers at Fred Hutchinson Cancer Research Center used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to find nearly 1,200 patients over the age of 66 who had been treated for advanced head and neck cancer between 2003 and 2007.

The study focused on patients with head and neck squamous cell carcinomas (HNSCCs).

Many patients are diagnosed with head and neck cancers that have already spread to nearby lymph nodes, which are important parts of the body’s immune system. The outlook for these locally advanced cancers is poor.

At this stage, the disease requires more than one type of treatment—what physicians call “multimodality therapy.”

National Comprehensive Cancer Network (NCCN) guidelines recommend multimodality therapy for advanced head and neck cancers that includes surgery followed by additional therapy (adjuvant therapy) or chemotherapy plus radiation.

Researchers theorized that HNSCC patients treated at high-volume hospitals would receive NCCN-recommended treatment. This was not the case, though. 

High-volume hospitals were defined as institutions that treated 15 or more HNSCC patients annually, and low volume hospitals treated fewer than 15 HNSCC patients.

NCCN guidelines were followed about 78 percent of the time at both types of facilities.

Treatment regimens were different between high- and low-volume hospitals, the researchers found. High-volume hospitals used surgery more frequently (56 percent) than low-volume hospitals did (46 percent).

The larger volume institutions used chemotherapy less often than low-volume facilities (18 percent versus 23 percent) and were more likely to treat with surgery and radiation only than were low-volume hospitals (27 percent versus 20 percent).

Patients treated at high-volume hospitals were 15 percent less likely to die of head and neck cancer than were patients treated at low-volume institutions, according to the study. HNSCC patients treated at an NCI-designated facility had 12 percent lower mortality (death) rates than did individuals treated at facilities without this designation.

"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.

This study was published March 1 in the journal Cancer. The research was funded through grants from the National Institute on Deafness and Other Communication Disorders, the National Cancer Institute and the National Center for Research Resources.

Dr. Mendez has a financial relationship with Intuitive Surgical, Inc. No other authors disclosed conflicts of interest.

Review Date: 
March 3, 2013