But the researchers with the Emory/ American Cancer Society study said that there is little historical information as to how the quality of care of laryngeal cancer patients affects their outcomes.
Explore This IssueNovember 2009
Laryngeal cancer is relatively uncommon, with 12,250 cases in the United States in 2008, compared to more than 110,000 cases of colon cancer, 180,000 cases of breast cancer and more than 210,000 cases of lung cancer.
Researchers hypothesized that the volume of laryngeal care influences the survival rate of patients, with high-volume facilities having better odds for survival.
They plumbed the National Cancer Database, a hospital-based registry supported jointly by the American Cancer Society and the American College of Surgeons that includes numbers for more than 1400 facilities approved by the Commission on Cancer. It is estimated that the database collects information on 70% of the incident cancer cases in the United States.
Researchers examined statistics from cases in which patients were diagnosed from 1996 to 2004 with Stage III and IV cancer. They ended up with 32,399 cases, having to exclude about 13% of the total because of missing information. They examined death rates for several factors, adjusting them for the other factors as they went.
Next to the 20% death rate within a year for teaching and research hospitals with high volumes of cases, comprehensive cancer centers with high volumes of cases had a 23% death rate, as did comprehensive cancer centers with a low volume. Then came teaching and research hospitals with a low volume and community hospitals with a high volume (both 24%), and finally community hospitals with a low volume of laryngeal cancer cases (26% death rate within a year).
Hazard ratios show that getting treated at a community hospital that treats a low number of laryngeal cancer patients results in a 33% increased risk of death than treatment at a teaching and research facility with a high volume.
The death rate within 90 days at teaching and research hospitals with a high volume was 3%, which was also superior to the other categories. All of the others had death rates of 4%, except community hospitals with low volumes of cases, which had a rate of 5%.
Variations Regarding Type of Treatment, Insurance
Researchers also examined the type of treatment. Patients who underwent a total laryngectomy had lower death rates after 90 days and one year, at 3% and 18%, respectively. The 90-day rate for both chemoradiation and radiation were 5%, and the death rate within a year was 27% for chemoradiation patients and 29% for radiation patients.