JAMA Otol Logo Orlando 2013 AHNS Meeting Location
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American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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COMBINED MODALITY TREATMENT OUTCOMES FOR HEAD AND NECK CANCER: COMPARISON OF CARE AT AN ACADEMIC CANCER CENTER VERSUS ACADEMIC-TO-COMMUNITY TRANSFER, 2002 - 2012

Presentation: S019
Topic: Clinical - Outcomes Research
Type: Oral Presentation
Date: Thursday, April 11, 2013
Session: 08:00 AM - 09:00 AM Thyroid / General
Authors: Jonathan R George, MD, MPH, Sue S Yom, MD, PhD, Steven J Wang, MD
Institution(s): University of California, San Francisco

 Objective: To evaluate differences in cancer outcomes between patients with head & neck squamous cell carcinoma who underwent primary surgical resection and postoperative adjuvant treatment at an academic center (AC) and those who underwent surgery at the AC and then received adjuvant treatment at a community-based non-AC closer to home.

Study Design: Retrospective cohort study

Methods: A retrospective cohort study was performed on all patients with primary mucosal head and neck squamous cell carcinoma treated with primary surgery followed by postoperative adjuvant radiation from 2002 to 2012. Demographic, oncologic, histologic, and adjuvant treatment data were collected. The authors then performed univariate and multivariate survival analyses of the effect of AC versus non-AC adjuvant treatment on cancer outcomes.

Results: 214 patients were included in this analysis. Significant differences in demographic variables existed between AC and non-AC groups. Patients returning home for adjuvant treatment at a community-based non-AC had a significantly lower average radiation therapy (RT) dose, fewer RT fractions, and lower dose per fraction compared to those receiving treatment at the AC. They also had significantly more RT delays, more breaks in RT, and more early termination of RT. The non-AC group had significantly lower overall survival (p=0.013), lower disease-specific survival (p=0.002), and lower locoregional control (p=0.044) compared to the AC treatment group. AC treatment was significantly associated with improved survival on univariate analysis (HR 0.53, 95% CI 0.32 - 0.88; p=0.015). This effect was not seen on multivariate survival analysis (HR 0.75, 95% CI 0.44-1.29; p=0.30).

Conclusion: Important differences were noted in the metrics of adjuvant radiation provided at the AC compared to those provided at the community-based non-ACs closer to the patients’ homes. Significantly better oncologic outcomes were also seen in the AC adjuvant treatment group as compared to the non-AC adjuvant treatment group, including significantly improved overall survival, disease-free survival, and locoregional control, as noted on univariate analysis. These outcomes were not upheld on multivariate analysis, a finding that may be explained by a priori demographic and oncologic differences noted between these groups.

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