Association of Type of Treatment Facility With Overall Survival After a Diagnosis of Head and Neck Cancer
Association of Type of Treatment Facility With Overall Survival After a Diagnosis of Head and Neck Cancer
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DOI：
10.1001/jamanetworkopen.2019.19697
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发表时间：
2020-01-24
影响因子：
13.8
通讯作者：
Brant, Jason A.
中科院分区：
文献类型：
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作者：
Carey, Ryan M.;Fathy, Ramie;Brant, Jason A.
这项队列研究使用国家癌症数据库的数据来检查治疗设施的类型是否与诊断为头颈癌的患者的总生存期相关。问题治疗设施的类型是否与头颈癌患者的总生存期相关？结果 在这项对 2004 年至 2016 年国家癌症数据库中 525740 名被诊断患有头颈部恶性肿瘤的患者进行的队列研究中，学术综合癌症项目、综合网络癌症项目和综合社区癌症项目的治疗与社区癌症项目的治疗相比，总体生存率更高。意义 这项研究的结果表明，提高对社会经济差异和肿瘤治疗差异的理解可能会改善头颈癌的临床结果。 重要性 头颈癌患者在学术综合癌症计划 (ACCP)、综合网络癌症计划 (INCP)、综合社区癌症计划 (CCCP) 和社区癌症计划 (CCP) 中接受护理。治疗设施的类型可能与总生存率相关。目的 检查治疗设施类型是否与头颈癌诊断后的总生存期相关。设计、设置和参与者 这项基于人群的回顾性队列研究包括来自国家癌症数据库的患者，该数据库是一个前瞻性维护的、基于医院的癌症登记系统，记录了在美国 1500 多家医院接受治疗的患者。参与者于2004年1月1日至2016年12月31日期间被诊断患有头颈部恶性肿瘤。对2019年5月1日至11月30日期间的数据进行分析。 暴露 在分类为 ACCP、INCP、CCCP 或 CCP 的设施中接受治疗。主要结果和措施头颈癌诊断和治疗后的总体生存率是主要结果。次要结果是在 ACCP 和 INCP 与 CCCP 和 CCP 接受治疗的几率。使用多变量Cox比例风险回归以及单变量和多变量逻辑回归模型进行分析。结果 研究期间共有 525740 名患者（368821 名男性 [70.2%]；平均 [SD] 年龄，63.3 [14.0] 岁）被诊断患有头颈部恶性肿瘤。其中，36595名患者（7.0%）在CCP接受治疗； 174658 (33.2%)，CCCP； 232867 (44.3%)，在 ACCP；和 57857 (11.0%)，在 INCP。呼吸消化癌患者的中位生存期为 69.2 (95% CI, 68.6-69.8) 个月；唾液腺癌，107.2（95% CI，103.9-110.2）个月；和皮肤癌，113.2 (95% CI, 111.4-114.6) 个月。与 CCP 相比，ACCP（风险比 [HR]，0.89；95% CI，0.88-0.91）、INCP（HR，0.94；95% CI，0.92-0.96）和 CCCP（HR，0.94；95% CI，0.92-0.95）治疗均能改善总生存期。与有私人保险的患者相比，有政府保险（比值比 [OR]，1.35；95% CI，1.29-1.41）、无保险（OR，1.12；95% CI，1.09-1.16）或医疗补助（OR，1.17；95% CI，1.14-1.20）的患者更有可能在 ACCP 接受治疗，并且INCP，而拥有 Medicare 的患者在 ACCP 和 INCP 接受治疗的可能性较小（OR，0.95；95% CI，0.94-0.97）。与白人患者相比，黑人（OR，1.55；95% CI，1.52-1.59）和亚洲人（OR，1.56；95% CI，1.49-1.63）患者更有可能在 ACCP 和 INCP 接受护理。与低收入地区的患者相比，高收入地区的患者更有可能在 ACCP 和 INCP 接受治疗（OR，1.25；95% CI，1.22-1.28）。结论和相关性这些研究结果表明，ACCP 和 INCP 的治疗与头颈癌患者更好的总生存率相关。健康的关键社会决定因素，如种族/民族、社会经济地位和保险类型，与在 ACCP 和 INCP 接受治疗有关。
This cohort study uses data from the National Cancer Database to examine whether the type of treatment facility is associated with overall survival among patients with a diagnosis of head and neck cancer.Question Is the type of treatment facility associated with overall survival in patients with head and neck cancer? Findings In this cohort study of 525740 patients diagnosed with malignant neoplasms of the head and neck in the National Cancer Database from 2004 to 2016, treatment at academic comprehensive cancer programs, integrated network cancer programs, and comprehensive community cancer programs was associated with better overall survival rates than treatment at community cancer programs. Meaning This study's findings suggest that improved understanding of socioeconomic differences and oncologic treatment disparities may improve clinical outcomes in head and neck cancer.Importance Patients with head and neck cancer receive care at academic comprehensive cancer programs (ACCPs), integrated network cancer programs (INCPs), comprehensive community cancer programs (CCCPs), and community cancer programs (CCPs). The type of treatment facility may be associated with overall survival. Objective To examine whether type of treatment facility is associated with overall survival after a diagnosis of head and neck cancer. Design, Setting, and Participants This population-based retrospective cohort study included patients from the National Cancer Database, a prospectively maintained, hospital-based cancer registry of patients treated at more than 1500 US hospitals. Participants were diagnosed with malignant tumors of the head and neck from January 1, 2004, through December 31, 2016. Data were analyzed from May 1 through November 30, 2019. Exposures Treatment at facilities classified as ACCPs, INCPs, CCCPs, or CCPs. Main Outcomes and Measures Overall survival after diagnosis and treatment of head and neck cancer was the primary outcome. The secondary outcome was the odds of receiving treatment at ACCPs and INCPs vs CCCPs and CCPs. Multivariable Cox proportional hazards regression and univariable and multivariable logistic regression models were used for analysis. Results A total of 525740 patients (368821 men [70.2%]; mean [SD] age, 63.3 [14.0] years) were diagnosed with malignant tumors of the head and neck during the study period. Among them, 36595 patients (7.0%) were treated at CCPs; 174658 (33.2%), at CCCPs; 232867 (44.3%), at ACCPs; and 57857 (11.0%), at INCPs. The median survival for patients with aerodigestive cancers was 69.2 (95% CI, 68.6-69.8) months; salivary gland cancers, 107.2 (95% CI, 103.9-110.2) months; and skin cancers, 113.2 (95% CI, 111.4-114.6) months. Improved overall survival was associated with treatment at ACCPs (hazard ratio [HR], 0.89; 95% CI, 0.88-0.91), INCPs (HR, 0.94; 95% CI, 0.92-0.96), and CCCPs (HR, 0.94; 95% CI, 0.92-0.95) compared with CCPs. Compared with patients with private insurance, those with government insurance (odds ratio [OR], 1.35; 95% CI, 1.29-1.41), no insurance (OR, 1.12; 95% CI, 1.09-1.16), or Medicaid (OR, 1.17; 95% CI, 1.14-1.20) were more likely to receive treatment at ACCPs and INCPs, whereas patients with Medicare were less likely to receive treatment at ACCPs and INCPs (OR, 0.95; 95% CI, 0.94-0.97). Compared with white patients, black (OR, 1.55; 95% CI, 1.52-1.59) and Asian (OR, 1.56; 95% CI, 1.49-1.63) patients were more likely to receive care at ACCPs and INCPs. Compared with patients from lower-income areas, patients from high-income areas were more likely to receive treatment at ACCPs and INCPs (OR, 1.25; 95% CI, 1.22-1.28). Conclusions and Relevance These findings suggest that treatment at ACCPs and INCPs was associated with a better overall survival rate in patients with head and neck cancer. Key social determinants of health such as race/ethnicity, socioeconomic status, and type of insurance were associated with receiving treatment at ACCPs and INCPs.