Improved Survival Is Associated With Treatment at High-Volume Teaching Facilities for Patients With Advanced Stage Laryngeal Cancer

BACKGROUND: Because of the multidisciplinary nature of treatment for advanced laryngeal cancer, the authors hypothesized that treatment at high-volume teaching/research facilities is associated with improved survival. METHODS: After exclusions, 19,326 patients who were diagnosed with advanced laryngeal cancer (stage III and IV) between 1996 and 2002 and who received treatment (chemoradiotherapy [CRT], total laryngectomy [TL], or radiotherapy [RT]) were analyzed from the National Cancer Database (NCDB). Facilities were classified into 6 groups (low-volume and high-volume teaching/research facilities, low-volume and high-volume community cancer centers, and low-volume and high-volume community facilities). Multivariate proportional hazards regression modeling was used to determine 90-day, 365-day, and 4-year hazard ratio (HR) estimates. RESULTS: Treatment included TL (37.6%), CRT (29.4%), and RT alone (33%). Overall, 36.2% of patients were treated at high-volume teaching/research centers (average, 17.1 cases per year). Among all patients, 20% died within the first year. In multivariate models that were controlled for covariates, 90-day, 365-day, and 4 year HR estimates for death were lowest for high-volume teaching/research centers. CONCLUSIONS: Receiving treatment at high-volume teaching/research facilities was associated with improved survival. Undergoing total laryngectomy also was associated with improved survival. The current results suggested that the regionalization of care for patients with advanced-stage laryngeal cancer has occurred, because most patients were treated either at high-volume teaching/research facilities or at high-volume community cancer centers. Future studies should investigate the factors associated with better survival at high-volume teaching/research facilities, such as quality of care, processes of care, and referral patterns. Cancer 2010; 116: 4744-52. (C) 2010 American Cancer Society.