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High-Volume Hospitals, Surgeons Better Predictors of Overall Survival in Head, Neck Cancer

by Amy Eckner •

Clinical Question

Does surgeon and/or institution resection volume predict long-term overall survival in head and neck cancer in a publicly funded healthcare system?

Background: Previous studies have demonstrated short- and long-term surgeon- and hospital-volume mortality relationships, but this has not been demonstrated for mucosal head and neck squamous cell carcinoma (HNSCC) or within a universal healthcare system. In Ontario, the Ontario Health Insurance Plan covers all oncology health services, with no alternate care or private care system.

Study design: Population-based retrospective cohort study of 5,720 head and neck cancer patients in Ontario, Canada, who underwent a resection between 1993 and 2010.

Setting: Ontario Cancer Registry (OCR), with data from multiple sites in Ontario, Canada.

Synopsis: In Ontario, 187 surgeons performed head and neck cancer resections in 72 hospitals. High-volume surgeons treated more patients from 2001 to 2010 than from 1992 to 2000 and operated on a larger proportion of patients who had received pre- and postoperative chemotherapy. High-volume institutions treated more patients from 2001 to 2010 than from 1992 to 2000, treated fewer rural patients, and treated a larger proportion of patients who had received pre- and postoperative chemotherapy. The display of hospital volume and overall survival (OS) showed an approximately linear relationship after an institution performed 75 cases per year; as volume increased from zero up to 75 cases per year, there appeared to be a paradoxical worsening of results. Similar results were shown for survival and volume for surgeons at 30 cases per year. Hospitals treating 75 patients per year had a 10-year OS of approximately 20%; those that treated 500 patients a year had a 10-year OS of approximately 40%. The most important limitation is a lack of stage and pathologic data.

Bottom line: Both high-volume surgeons and hospitals are predictors of better overall survival in head and neck cancer patients, but the effect is largely explained by hospital volume.

Citation: Eskander A, Irish J, Groome PA, et al. Volume-outcome relationships for head and neck cancer surgery in a universal healthcare system. Laryngoscope. 2014;124:2081-2088.

—Reviewed by Amy Eckner