Comparison of facility type outcomes for oral cavity cancer: Analysis of the national cancer database

Objective: Determine whether facility type effects overall survival in patients with oral cavity cancer.

Study design: Retrospective cohort study.

Methods: Patients included in the National Cancer Database who were diagnosed with oral cavity cancer between 1998 and 2011 were included in the study. Data was stratified by facility where care was provided, including community cancer programs (CCP), comprehensive community cancer programs (CCCP), and academic centers (AC). Univariate analysis was performed using analysis of variance, chi squared, and log-rank test, whereas multivariate analysis was performed using Cox regression.

Results: A total of 32,510 patients were included in the study, with 7.58% of patients receiving care at CCPs (n = 2,553), 39.53% at CCCPs (n = 12,852), and 52.61% at ACs (n = 17,105). Between 1998 and 2011, there was a greater percentage of patients receiving care at ACs, and a greater percentage of patients receiving surgical therapy versus nonsurgical therapy. Patients treated at ACs had the best 5-year overall survival of 51.26%, with a significant difference across facility types (P < 0.01). After adjusting for confounders, receiving care at ACs was a positive predictor of survival (hazard ratio: 0.95 95% confidence interval [0.91,0.98])).

Conclusion: Patients treated at ACs are more likely to receive surgical treatment, and have a greater 5-year overall survival compared to those patients treated at CCPs and CCCPs. Therefore, we advocate referring patients with advanced oral cavity cancers to ACs.

Level of evidence: 4. Laryngoscope, 127:2551-2557, 2017.