title: Improved survival is associated with treatment at high-volume teaching facilities for patients with advanced stage laryngeal cancer.
abstract: BACKGROUND
  Because of the multidisciplinary nature of treatment for advanced laryngeal cancer, the authors hypothesized that treatment at high-volume teaching/research facilities is associated with improved survival.
  
  
  METHODS
  After exclusions, 19,326 patients who were diagnosed with advanced laryngeal cancer (stage III and IV) between 1996 and 2002 and who received treatment (chemoradiotherapy [CRT], total laryngectomy [TL], or radiotherapy [RT]) were analyzed from the National Cancer Database (NCDB). Facilities were classified into 6 groups (low-volume and high-volume teaching/research facilities, low-volume and high-volume community cancer centers, and low-volume and high-volume community facilities). Multivariate proportional hazards regression modeling was used to determine 90-day, 365-day, and 4-year hazard ratio (HR) estimates.
  
  
  RESULTS
  Treatment included TL (37.6%), CRT (29.4%), and RT alone (33%). Overall, 36.2% of patients were treated at high-volume teaching/research centers (average, 17.1 cases per year). Among all patients, 20% died within the first year. In multivariate models that were controlled for covariates, 90-day, 365-day, and 4 year HR estimates for death were lowest for high-volume teaching/research centers.
  
  
  CONCLUSIONS
  Receiving treatment at high-volume teaching/research facilities was associated with improved survival. Undergoing total laryngectomy also was associated with improved survival. The current results suggested that the regionalization of care for patients with advanced-stage laryngeal cancer has occurred, because most patients were treated either at high-volume teaching/research facilities or at high-volume community cancer centers. Future studies should investigate the factors associated with better survival at high-volume teaching/research facilities, such as quality of care, processes of care, and referral patterns.
authors.affiliation: Department of Surveillance and Health Policy Research, American Cancer Society, Atlanta, Georgia 30303, USA. achen@emory.edu
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Chen
authors.forename: Stacey
authors.initials: S
authors.lastname: Fedewa
authors.forename: Alex
authors.initials: A
authors.lastname: Pavluck
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Ward
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D019992:Databases as Topic; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D012042:Registries; D016019:Survival Analysis