TY - JOUR
T1 - The effect of treating institution on outcomes in head and neck cancer
AU - Lassig, Amy Anne D.
AU - Joseph, Anne M.
AU - Lindgren, Bruce R.
AU - Fernandes, Patricia
AU - Cooper, Sarah
AU - Schotzko, Chelsea
AU - Khariwala, Samir
AU - Reynolds, Margaret
AU - Yueh, Bevan
N1 - Funding Information:
The authors express their most sincere thanks to the American Academy of Otolaryngology–Head and Neck Surgery for graciously supporting this work via the Rande H. Lazar Health Services Research Grant.
PY - 2012/12
Y1 - 2012/12
N2 - Objective. Factors leading patients with head and neck cancer (HNCA) to seek radiation or chemoradiation in an academic center versus the community are incompletely understood, as are the effects of site of treatment on treatment completion and survival. Study Design. Historical cohort study. Setting. Tertiary academic center, community practices. Methods. A historical cohort study was completed of patients with mucosal HNCA identified by International Classification of Disease, Ninth Revision (ICD-9) codes receiving consultation at the authors' institution from 2003 to 2008. Patients who received primary and adjuvant radiation at an academic center or in the community were included. The authors compared treatment completion rates and performed univariate and multivariate analyses of treatment outcomes. Results. Of 388 patients, 210 completed treatment at an academic center and 145 at a community center (33 excluded, location unknown). Patients with HNCA undergoing radiation at an academic site had more advanced disease (P = .024) and were more likely to receive concurrent chemotherapy. Academic hospitals had a higher percentage of noncurrent smokers, higher median income, and higher percentage of oropharyngeal tumors. There was no significant difference in the rate of planned treatment completion between community and academic centers (93.7% vs 94.7%, P . .81) or rate of treatment breaks (22.4% vs 28.4%, P . .28). On Kaplan-Meier analysis, the 5-year survival rate was 53.2% (95% confidence interval [CI], 45.3%-61.1%) for academic centers and 32.8% (95% CI, 22.0%-43.6%) for community hospitals (P<.001). Conclusion. In this cohort, although treatment completion and treatment breaks were similar between academic and community centers, survival rates were higher in patients treated in an academic setting.
AB - Objective. Factors leading patients with head and neck cancer (HNCA) to seek radiation or chemoradiation in an academic center versus the community are incompletely understood, as are the effects of site of treatment on treatment completion and survival. Study Design. Historical cohort study. Setting. Tertiary academic center, community practices. Methods. A historical cohort study was completed of patients with mucosal HNCA identified by International Classification of Disease, Ninth Revision (ICD-9) codes receiving consultation at the authors' institution from 2003 to 2008. Patients who received primary and adjuvant radiation at an academic center or in the community were included. The authors compared treatment completion rates and performed univariate and multivariate analyses of treatment outcomes. Results. Of 388 patients, 210 completed treatment at an academic center and 145 at a community center (33 excluded, location unknown). Patients with HNCA undergoing radiation at an academic site had more advanced disease (P = .024) and were more likely to receive concurrent chemotherapy. Academic hospitals had a higher percentage of noncurrent smokers, higher median income, and higher percentage of oropharyngeal tumors. There was no significant difference in the rate of planned treatment completion between community and academic centers (93.7% vs 94.7%, P . .81) or rate of treatment breaks (22.4% vs 28.4%, P . .28). On Kaplan-Meier analysis, the 5-year survival rate was 53.2% (95% confidence interval [CI], 45.3%-61.1%) for academic centers and 32.8% (95% CI, 22.0%-43.6%) for community hospitals (P<.001). Conclusion. In this cohort, although treatment completion and treatment breaks were similar between academic and community centers, survival rates were higher in patients treated in an academic setting.
KW - Head and neck cancer
KW - Outcomes
KW - Radiation
KW - Treating institution
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U2 - 10.1177/0194599812457324
DO - 10.1177/0194599812457324
M3 - Article
C2 - 22875780
AN - SCOPUS:84872677167
SN - 0194-5998
VL - 147
SP - 1083
EP - 1092
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 6
ER -