Cancer Outcomes Better in Specialty Centers
Where you’re treated does appear to play a role in your survival, at least for some types of cancer, according to a study of older people with advanced head and neck cancers.
Researchers found that patients treated at hospitals with a large number of head and neck cancers were 15 percent less likely to die of their disease as compared to patients who were treated at hospitals treating a low number of of people with the cancers. Investigators also found that such patients were 12 percent less likely to die of their disease when treated at a National Cancer Institute.
“Where you’re treated matters,” says corresponding study author Eduardo Méndez, M.D., an assistant member of the Clinical Research Division at Fred Hutchinson Cancer Research Center in Seattle.
Do High-Volume Hospitals Do Better Job?
Because of the complexity of treating these types of cancer, Méndez and colleagues theorized 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 National Comprehensive Cancer Network guidelines. However, that was not their finding.
According to the American Cancer Society, 52,610 Americans were newly diagnosed with head and neck cancer in 2012. Many patients are diagnosed with locally advanced disease that has spread to the lymph nodes When this happens, the prognosis is much worse.
Patients with advanced disease require management by a collaborative team representing many physician specialties.
For almost all advanced cases, NCCN guidelines recommend “multimodality” therapy, of some combination of surgery, chemotherapy or radiation.
‘Multimodality Therapy’ Similar for Differing Hospitals
Even though the researchers found that even though there was better survival at high-volume hospitals, the proportion of patients who received multimodality therapy was similar – 78 percent and 79 percent – at low- and 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,” says Méndez, whose specialty is surgical treatment of head and neck cancer 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 conclude.
Toxicity Hinders Following Guidelines
Nevertheless, following NCCN guidelines can be difficult, because of the toxic effects of the treatments. Managing these effects require a lot of support, which is typically found at comprehensive cancer centers, Mendez adds.
Prior research in cancers other than HNSCC have shown that hospital volume and physician volume influence outcomes. However, this is the first study to examine whether hospital factors are associated with receiving multimodality therapy for patients with advanced HNSCC.