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14-03-2013 | Surgery | Article

Hospital volume impacts survival in advanced HNSCC


Free abstract

medwireNews: Higher hospital volume is associated with better survival in patients with advanced head and neck squamous cell carcinoma (HNSCC), an analysis of US data suggests.

The researchers suggest that identifying institutional factors that drive the better outcomes in high-volume hospitals could help to improve survival for all patients.

Eduardo Méndez (Fred Hutchinson Cancer Research Center, Seattle, Washington) and team analyzed data on 1195 Medicare patients with advanced HNSCC who were included in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 2003 and 2007.

The patients' median age was 73 years, 68% were male, 90% were White, and all had T3, T4, N2, or N3 stage disease.

Hospital volume was defined as the number of patients with HNSCC treated by each hospital and classified as being low or high using the median value.

Analysis showed that patients treated at high-volume hospitals were more often treated with surgery than those attending low-volume hospitals (56 vs 46%), less often received cisplatin (18 vs 23%), and were more often given surgery and radiation only (27 vs 20%).

In multivariate analysis, hospital characteristics were not associated with receiving multimodality therapy, whereas treatment at a high-volume hospital or at a hospital designated as a National Cancer Institute (NCI) cancer center was associated with better survival, with hazard ratios of 0.85 and 0.88, respectively.

Other predictors for survival included age, Charlson comorbidity index, tumor stage, and treatment with surgery or cisplatin. Neither radiation nor chemotherapy was associated with survival, however.

Writing in Cancer, Méndez and colleagues express surprise that patients treated at high-volume hospitals were not more likely to receive multimodality therapy (ie, surgery and adjuvant therapy or primary chemoradiation), as is recommended in National Comprehensive Cancer Network (NCCN) guidelines.

Nevertheless, these patients had improved survival when compared with patients treated at low-volume hospitals. This is the first study to show such an association, the authors remark.

They write: "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.

"Studying and implementing these institutional factors may be effective in narrowing the disparity in survival across hospitals that was found in this study."

By Joanna Lyford, Senior medwireNews Reporter

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