title: Importance of Radiation Oncologist Experience Among Patients With Head-and-Neck Cancer Treated With Intensity-Modulated Radiation Therapy.
abstract: OBJECTIVE
  Over the past decade, intensity-modulated radiation therapy (IMRT) has replaced conventional radiation techniques in the management of head-and-neck cancers (HNCs). We conducted this population-based study to evaluate the influence of radiation oncologist experience on outcomes in patients with HNC treated with IMRT compared with patients with HNC treated with conventional radiation therapy.
  
  
  METHODS
  We identified radiation providers from Medicare claims of 6,212 Medicare beneficiaries with HNC treated between 2000 and 2009. We analyzed the impact of provider volume on all-cause mortality, HNC mortality, and toxicity end points after treatment with either conventional radiation therapy or IMRT. All analyses were performed by using either multivariable Cox proportional hazards or Fine-Gray regression models controlling for potential confounding variables.
  
  
  RESULTS
  Among patients treated with conventional radiation, we found no significant relationship between provider volume and patient survival or any toxicity end point. Among patients receiving IMRT, those treated by higher-volume radiation oncologists had improved survival compared with those treated by low-volume providers. The risk of all-cause mortality decreased by 21% for every additional five patients treated per provider per year (hazard ratio [HR], 0.79; 95% CI, 0.67 to 0.94). Patients treated with IMRT by higher-volume providers had decreased HNC-specific mortality (subdistribution HR, 0.68; 95% CI, 0.50 to 0.91) and decreased risk of aspiration pneumonia (subdistribution HR, 0.72; 95% CI, 0.52 to 0.99).
  
  
  CONCLUSIONS
  Patients receiving IMRT for HNC had improved outcomes when treated by higher-volume providers. These findings will better inform patients and providers when making decisions about treatment, and emphasize the critical importance of high-quality radiation therapy for optimal treatment of HNC.
authors.affiliation: Isabel J. Boero, Anthony J. Paravati, Ezra E.W. Cohen, Loren K. Mell, and James D. Murphy, University of California San Diego, La Jolla; Quynh-Thu Le, Stanford University, Stanford, CA; and Beibei Xu, Peking University, Beijing, People's Republic of China.
authors.forename: Isabel J
authors.initials: IJ
authors.lastname: Boero
authors.affiliation: Isabel J. Boero, Anthony J. Paravati, Ezra E.W. Cohen, Loren K. Mell, and James D. Murphy, University of California San Diego, La Jolla; Quynh-Thu Le, Stanford University, Stanford, CA; and Beibei Xu, Peking University, Beijing, People's Republic of China.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Paravati
authors.affiliation: Isabel J. Boero, Anthony J. Paravati, Ezra E.W. Cohen, Loren K. Mell, and James D. Murphy, University of California San Diego, La Jolla; Quynh-Thu Le, Stanford University, Stanford, CA; and Beibei Xu, Peking University, Beijing, People's Republic of China.
authors.forename: Beibei
authors.initials: B
authors.lastname: Xu
authors.affiliation: Isabel J. Boero, Anthony J. Paravati, Ezra E.W. Cohen, Loren K. Mell, and James D. Murphy, University of California San Diego, La Jolla; Quynh-Thu Le, Stanford University, Stanford, CA; and Beibei Xu, Peking University, Beijing, People's Republic of China.
authors.forename: Ezra E W
authors.initials: EE
authors.lastname: Cohen
authors.affiliation: Isabel J. Boero, Anthony J. Paravati, Ezra E.W. Cohen, Loren K. Mell, and James D. Murphy, University of California San Diego, La Jolla; Quynh-Thu Le, Stanford University, Stanford, CA; and Beibei Xu, Peking University, Beijing, People's Republic of China.
authors.forename: Loren K
authors.initials: LK
authors.lastname: Mell
authors.affiliation: Isabel J. Boero, Anthony J. Paravati, Ezra E.W. Cohen, Loren K. Mell, and James D. Murphy, University of California San Diego, La Jolla; Quynh-Thu Le, Stanford University, Stanford, CA; and Beibei Xu, Peking University, Beijing, People's Republic of China.
authors.forename: Quynh-Thu
authors.initials: QT
authors.lastname: Le
authors.affiliation: Isabel J. Boero, Anthony J. Paravati, Ezra E.W. Cohen, Loren K. Mell, and James D. Murphy, University of California San Diego, La Jolla; Quynh-Thu Le, Stanford University, Stanford, CA; and Beibei Xu, Peking University, Beijing, People's Republic of China. j2murphy@ucsd.edu.
authors.forename: James D
authors.initials: JD
authors.lastname: Murphy
mesh_terms: D002423:Cause of Death; D002983:Clinical Competence; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D006278:Medicare; D010043:Outcome and Process Assessment, Health Care; D050397:Radiotherapy, Intensity-Modulated / Q000592:standards*; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D014481:United States