Hospital volume is associated with survival but not multimodality therapy in Medicare patients with advanced head and neck cancer

Cancer. 2013 May 15;119(10):1845-52. doi: 10.1002/cncr.27976. Epub 2013 Mar 1.


Background: Given the complexity of management of advanced head and neck squamous cell carcinoma (HNSCC), this study hypothesized that high hospital volume would be associated with receiving National Comprehensive Cancer Network (NCCN) guideline therapy and improved survival in patients with advanced HNSCC.

Methods: The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify patients with advanced HNSCC. Treatment modalities and survival were determined using Medicare data. Hospital volume was determined by the number of patients with HNSCC treated at each hospital.

Results: There were 1195 patients with advanced HNSCC who met inclusion criteria. In multivariable analyses, high hospital volume was not associated with receiving multimodality therapy per NCCN guidelines (odds ratio = 1.02, 95% confidence interval = 0.66-1.60), but showed a nearly significant inverse association with survival in a model adjusted for National Cancer Institute-designated cancer center status, age, sex, race, socioeconomic status, marital status, comorbidity, year of diagnosis, tumor site, and tumor stage (hazard ratio = 0.85, 95% confidence interval = 0.69-1.04).

Conclusions: Medicare patients with advanced HNSCC treated at high-volume hospitals were not more likely to receive NCCN guideline therapy, but had nearly statistically significant better survival, when compared with patients treated at low-volume hospitals. These results suggest that features of high-volume hospitals other than delivery of NCCN guideline therapy influence survival. Cancer 2013. © 2013 American Cancer Society.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy
  • Chemotherapy, Adjuvant
  • Female
  • Head and Neck Neoplasms / mortality*
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy
  • Hospitals, High-Volume / standards
  • Hospitals, High-Volume / statistics & numerical data*
  • Hospitals, Low-Volume / statistics & numerical data*
  • Humans
  • Interdisciplinary Communication
  • Kaplan-Meier Estimate
  • Male
  • Medicare
  • Multivariate Analysis
  • Odds Ratio
  • Oncology Service, Hospital / standards
  • Oncology Service, Hospital / statistics & numerical data*
  • Patient Care Team
  • Radiotherapy, Adjuvant
  • Risk Factors
  • SEER Program
  • Treatment Outcome
  • United States / epidemiology