The hazard ratios showed that the chances of dying within one year were 50% higher for those getting chemoradiation than for those getting a total laryngectomy, researchers said. Dr. Chen cautioned, though, that the numbers might not be so straightforward because those rejected for laryngectomy would probably then be sent for chemoradiation.
Explore This IssueNovember 2009
The type of insurance also had a close tie to the outcomes of patients. Those with private insurance (16% death rate at one year) fared the best. They were followed by those patients 65 or older with Medicare (18% rate), those with government insurance (23%), those without insurance (24%), those on Medicaid (26%) and those on Medicare who were younger than 65 (27% death rate within a year).
Basically, if you don’t have private health insurance, you are at increased risk of death, Dr. Chen said.
There were little or no statistical differences for death rates when it came to race and education level, researchers found.
Despite the vast amount of information available in the National Cancer Database, there isn’t much information available for some types of institutions, Dr. Chen said.
There is little information on the quality of care of treatment of laryngeal cancer, particularly with the nonsurgical facilities, she said. We really don’t know about the care of the chemotherapy facilities or radiation facilities and, together, how that impacts outcomes. So we’ll not only need to evaluate surgical expertise and surgical outcomes, but we should also measure what happens when they don’t get treated by surgeons.
The ties between the death rates and the facility type and case volume are compelling, Dr. Chen said.
Recommendations for Action
There are a lot of reasons why this may be happening, and it would be important to drill down a little bit further to figure out why we are having better outcomes at high-volume teaching research hospitals, so that those processes of care can be implemented in other facilities, she said. And hopefully all patients can yield the same results across the board.
Dr. Chen was questioned on whether community hospitals should, in fact, try to take on more rare procedures. I’m not sure that community hospitals ought to be brought up to speed where they can maybe do rare surgical procedures, an audience member said. That may not be the most effective place to deliver that care. Perhaps we ought to focus on regional centers and tertiary centers for rare operations.