Varying Overall Survival Indicated Depending on Institution for Patients with HNC

January 30, 2020

Patients with head and neck cancer saw better overall survival when treated at academic comprehensive cancer programs and integrated network cancer programs, compared to comprehensive community cancer programs and community cancer programs.

Treatment at academic comprehensive cancer programs (AACPs) and integrated network cancer programs (INCPs) was associated with an improved overall survival in patients with head and neck cancer, according to a study published in JAMA Network Open

Researchers also indicated that key social factors of health such as race/ethnicity, socioeconomic status, and type of insurance were associated with receiving treatment at AACPs and INCPs. 

“Socioeconomic and health disparities affect where patients ultimately receive their treatment,” the authors wrote. “Improved access to care for patients from lower socioeconomic status may ultimately help improve these individuals’ outcomes.” 

Using patients from the National Cancer Database (NCDB), a total of 525,740 patients diagnosed with malignant tumors of the head and neck were identified during the study period. Of this cohort, 36,595 (7%) were treated at community cancer programs (CCPs), 174,658 (33.2%) at comprehensive community cancer programs (CCCPs), 232,867 (44.3%) at AACPs, and 57,857 (11%) at INCPs. 

The median survival for patients with aerodigestive cancers was 69.2 (95% CI, 68.6-69.8) months, 107.2 (95% CI, 103.9-110.2) months for patients with salivary gland cancers, and 113.2 (95% CI, 111.4-114.6) months for patients with skin cancers. Better overall survival was associated with treatment at ACCPs (hazard ratio [HR], 0.89; 95% CI, 0.88-0.91), INCPs (HR, 0.94; 95% CI, 0.92-0.96), and CCCPs (HR, 0.94; 95% CI, 0.92-0.95) compared to those treated at CCPs. More specifically, patients who received radiotherapy at ACCPs, INCPs, and CCCPs were shown to have improved overall survival compared to those receiving radiotherapy at CCPs. 

When compared with those who had private insurance, those who had government insurance (OR, 1.17; 95% CI, 1.14-1.20) were more likely to receive treatment at ACCPs and INCPs, whereas patients with Medicare were less likely to receive treatment at these locations (OR, 0.95; 95% CI, 0.94-0.97). Compared to white patients, black (OR, 1.55; 95% CI, 1.52-1.59) and Asian (OR, 1.56; 95% CI, 1.49-1.63) patients were more likely to receive care at ACCPs and INCPs. Moreover, patients from higher-income areas were found to be more likely to receive treatment at ACCPs and INCPs (OR, 1.25; 95% CI, 1.22-1.28) than those from lower-income areas. 

“These findings may reflect a proximity bias and could be related to the demographic characteristics of individuals who most often live in areas where ACCPs and INCPs tend to be located,” the authors wrote. 

Notably, the NCDB may have led to potential issues with accuracy and confounding. The researchers indicated that confounding is a known issue with data sets such as this given that clinically relevant variables such as tobacco smoking, which is an important association with head and neck cancer, are missing. Additionally, the researchers attempted to control for advances in treatment for this cancer type, however they were not able to account for differences in treatment techniques. 

According to the study, approximately 4% of all cancers in the US are attributed to malignant tumors of the head and neck. Treatment of this cancer type involves collaboration between multiple specialties for optimal treatment, and these treatments often vary widely between types of institutions.

Reference:

Carey RM, Fathy R, Shah RR, et al. Association of Type of Treatment Facility With Overall Survival After a Diagnosis of Head and Neck Cancer. JAMA Network Open. doi:10.1001/jamanetworkopen.2019.19697.