Facility and Case Volume Tied to Cancer Death Rates

Patients with cancer of the larynx who are treated at teaching and research hospitals that see high volumes of such patients are the least likely to die within a year of their diagnoses, researchers said at the annual meeting of the American Head and Neck Society.

According to a review of more than 30,000 cases of laryngeal cancer over nearly a decade using the National Cancer Database, laryngeal cancer patients at high-volume teaching and research medical centers had a 20% rate of death within a year-a significantly lower number than at any other type of hospital. It was even significantly lower than the rates at other teaching and research hospitals that see fewer cases of laryngeal cancer, according to an analysis by researchers at Emory University and the American Cancer Society in Atlanta.

The study shows a close tie between the type of institution and its volume of laryngeal cancer cases and the likelihood of whether a patient will live or die, which researchers say invites a closer look at how to alter the way patients with cancer of the larynx are cared for.

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.
-Amy Y. Chen, MD, MPH

Where one gets treated is clearly associated with survival, said Amy Y. Chen, MD, MPH, of the Emory Winship Cancer Institute. There have been lots of papers done on surgical volumes and outcomes, but most report 30-day mortality rates and none of them have looked at such a large cohort. There’s been little done in head and neck oncology and looking at one-year and 90-day outcomes.

Factors Related to Survival Rates

The findings were part of a broad look at many factors and how they relate to the survival rates of those with laryngeal cancer. The study examined access to quality care, demographic factors, as well as the facilities at which they were treated.

Patient factors that can affect survival include the clinical characteristics of the tumor, demographics, and the kind of insurance a patient has. Factors involving the physician include the training level, expertise at treating this type of cancer, and the volume of the cases seen.

A 2007 study published in the Journal of the National Cancer Institute (2007;99: 1171-7) showed that the five-year probability that a patient who had received a radical prostatectomy would remain free of a biochemical recurrence increased as the number of surgeries previously performed by that surgeon increased. The increase was sharpest from zero to about 250 surgeries, showing a steep learning curve.