Treatment in community cancer centers may be associated with a lower rate of survival among patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma of the oropharynx, according to a recent study published by Trakimas et al in the Journal of the National Cancer Institute. The new findings raised concerns about the quality of care that patients may receive outside of academic medical centers.
Background
HPV-related tumors in the oropharynx—which consists of structures in the back of the throat such as the base of the tongue, tonsils, and soft palate—account for the majority of the approximately 15,000 new cases of oropharyngeal cancers diagnosed in the United States each year.
Care for patients with HPV-related oropharyngeal cancer has recently seen a shift toward community cancer centers.
“The site of care determines patient outcomes and may influence the therapy landscape and survival for [patients with] these rare head and neck cancers in the future,” emphasized senior study author Carole Fakhry, MD, MPH, Director of the Head and Neck Cancer Center at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.
Study Methods and Results
In the new study, investigators used the U.S. National Cancer Database to examine the outcomes of over 20,000 patients with HPV-related oropharyngeal squamous cell carcinoma who were treated between 2010 and 2019.
The investigators found that although about two-thirds of the patients received care at academic cancer centers, the proportion of the patients receiving care at community cancer centers increased from 24% in 2010 to 36% in 2019. The investigators noted that if these trends were to continue, as many as 50% of all patients with HPV-related oropharyngeal squamous cell carcinoma may be treated at community cancer centers by 2030.
This trend may be attributed to growing comfort by clinicians at community cancer centers in treating these types of cancers. However, the quality of care that patients often receive in community cancer centers may be lag behind the quality of care offered to patients treated at academic cancer centers. For instance, more patients at community cancer centers are receiving nonsurgical radiation-based therapy. The number of patients receiving nonsurgical treatment increased from 62% to 74% during the study period.
The investigators also discovered that the patients who were treated at community cancer centers were less likely to receive surgery recommended by national guidelines and more likely to receive radiation as primary therapy.
As a result, survival among patients treated at community cancer centers vs academic cancer centers has also started to diverge in recent years. Between 2010 and 2013, survival rates for patients treated at the two types of centers were similar; whereas between 2014 and 2017, about 87% of the patients treated at academic cancer centers survived compared with about 81% of those treated at community cancer centers.
Conclusions
The investigators stressed that these trends may have important implications for the future quality of cancer care.
“Volume at academic centers is important to train the next generation of physicians. Additionally, if radiation is the primary modality of the future in community [cancer] centers, there may be a greater need for radiation oncologists and the multidisciplinary team, which is critical to the guideline-directed care of these patients,” underscored lead study author Danielle Trakimas, MD, an otolaryngology resident at the Johns Hopkins Hospital. “If patients with these head and neck cancers are less likely to be treated at academic [cancer] centers, we need to better understand the determinants of differences in survival outcomes,” she added.
The new research could also bolster evidence that higher-volume treatment centers may have greater outcomes compared with lower-volume centers. Academic cancer centers specializing in treating rare head and neck cancers may be more likely to offer transoral robotic surgery and may be better equipped to provide multidisciplinary team care and wrap-around services—which could lead to improved patient outcomes.
“It raises the question of whether we should focus care for HPV-related oropharyngeal squamous cell carcinomas at high-volume academic centers to optimize care,” Dr. Fakhry concluded.
Disclosure: The research in this study was supported by the National Institutes of Health. For full disclosures of the study authors, visit academic.oup.com.
