The Effect of Treating Institution on Outcomes in HNCA

Abstract

Objective: Factors leading HNCA patients to seek radiation in a community vs academic center are incompletely described as are the effects of treating institution on outcomes. We investigated HNCA patient characteristics associated with community vs academic radiation, likelihood of successful treatment completion in both settings, and resulting survival data. Method: A retrospective chart review was completed of all mucosal head and neck cancer patients who were treated at our institution from 2003 to 2008. Patients who received primary and adjuvant radiation were included. Numerous demographic and clinical variables were recorded, and statistical analysis was completed. Results: A total of 386 patients were identified of which 146 patients completed treatment in the community and 213 at an academic center (27 excluded, location unknown). There was no significant difference in rate of planned treatment completion between community (94.5%) and academic centers (93.8%) ( P = 1.000), or rate of treatment breaks, 23.1% and 26.9%, respectively ( P = .506). The academic group, however, had more advanced disease ( P = .021). The survival rate over time was statistically significant ( P = .003), with academic hospitals having better survival. The 5-year survival rate for academic and community hospitals was 55.9% (95% CI = 48.1% - 63.7%) and 42.9% (95% CI = 31.1% -54.6%), respectively. Conclusion: At our institution, HNCA patients more frequently received radiation in an academic clinic. While rate of treatment completion and treatment breaks were similar between academic and community centers, academic centers treated more advanced cancer. Despite this, survival rates were better in patients treated in an academic setting.