Abstract
Introduction: Significant progress has been made in the management of patients with Merkel cell carcinoma over the last decade. It is unclear how the type of the health care facility at which treatment occurs may alter patient outcomes. Methods: Data from Merkel cell cancers (MCCs) reported to the National Cancer Data Base (NCDB) between 2004-2017 were examined. Type of institutions were: Academic/Research Cancer Program (ARP), Comprehensive Community Cancer Program (CCCP); Integrated Network Cancer Program (INCP) and Community Cancer Program (CCP). Results: A total of 15,771 patients with MCCs and known institution type and disease stage where they received treatment and disease stage were analyzed. The majority of patients were treated at an ARP (n = 7190, 45.6%) or a CCCP (n = 5688, 36.1%). Patients treated at ARP were younger (ARP = 73.4 yrs vs CCCP = 75.2 yrs, CCP = 74.9 yrs, INCP = 74.3 yrs; P < .001) and had a higher percentage of Charlson/Deyo score of 0 (ARP = 74.7%, CCCP = 70.9%, CCP = 73.1%, INCP = 72.8; P < .001). Treatment at ARPs was associated with improved overall survival (median OS: ARPs: 75 mo, CCCP: 46 mo, CCP: 34.3 mo, INCP: 51.9 mo; P < .001). The difference in survival persistent for stage 1 (median OS: ARPs: 101 mo, CCCP: 74.9 mo, CCP: 77.1 mo, INCP: 93.4 mo; P < .001), stage 2 (median OS: ARPs: 63.6 mo, CCCP: 41 mo, CCP: 31.7 mo, INCP: 48.9 mo; P < .001), stage 3 (median OS: ARPs: 51.9 mo, CCCP: 34.5 mo, CCP: 27.2 mo, INCP: 36.5 mo; P < .001) and stage 4 (median OS: ARPs: 11.6.6 mo, CCCP: 10 mo, CCP: 10.1 mo, INCP: 9.4 mo; P < .005). Treatment at ARP was associated with more frequent use of immunotherapy (ARP = 2.1%, CCCP = 1.3%, CCP = 1.3%, INCP = 1.5%; P = .001). Conclusions: Treatment of MCC at ARPs is associated with improved overall survival. The association of improved outcomes with ARP persist for early and late disease stages.
Published Version
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