title: The effect of treating institution on outcomes in head and neck cancer.
abstract: OBJECTIVE
  Factors leading patients with head and neck cancer (HNCA) to seek radiation or chemoradiation in an academic center versus the community are incompletely understood, as are the effects of site of treatment on treatment completion and survival.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  Tertiary academic center, community practices.
  
  
  METHODS
  A historical cohort study was completed of patients with mucosal HNCA identified by International Classification of Disease, Ninth Revision (ICD-9) codes receiving consultation at the authors' institution from 2003 to 2008. Patients who received primary and adjuvant radiation at an academic center or in the community were included. The authors compared treatment completion rates and performed univariate and multivariate analyses of treatment outcomes.
  
  
  RESULTS
  Of 388 patients, 210 completed treatment at an academic center and 145 at a community center (33 excluded, location unknown). Patients with HNCA undergoing radiation at an academic site had more advanced disease (P = .024) and were more likely to receive concurrent chemotherapy. Academic hospitals had a higher percentage of noncurrent smokers, higher median income, and higher percentage of oropharyngeal tumors. There was no significant difference in the rate of planned treatment completion between community and academic centers (93.7% vs 94.7%, P > .81) or rate of treatment breaks (22.4% vs 28.4%, P > .28). On Kaplan-Meier analysis, the 5-year survival rate was 53.2% (95% confidence interval [CI], 45.3%-61.1%) for academic centers and 32.8% (95% CI, 22.0%-43.6%) for community hospitals (P < .001).
  
  
  CONCLUSIONS
  In this cohort, although treatment completion and treatment breaks were similar between academic and community centers, survival rates were higher in patients treated in an academic setting.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Amy Anne D
authors.initials: AA
authors.lastname: Lassig
authors.forename: Anne M
authors.initials: AM
authors.lastname: Joseph
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Lindgren
authors.forename: Patricia
authors.initials: P
authors.lastname: Fernandes
authors.forename: Sarah
authors.initials: S
authors.lastname: Cooper
authors.forename: Chelsea
authors.initials: C
authors.lastname: Schotzko
authors.forename: Samir
authors.initials: S
authors.lastname: Khariwala
authors.forename: Margaret
authors.initials: M
authors.lastname: Reynolds
authors.forename: Bevan
authors.initials: B
authors.lastname: Yueh
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D015438:Health Behavior; D006297:Health Services Accessibility; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate