A team of Yale oncological researchers found that patients with head and neck cancers exhibited lower mortality rates on average when treated at hospitals that dealt with more of these cases annually. Their study, however, is just one piece in a series of similar research that, taken together, reveals a broader trend in oncology and raises ethical questions about accessibility of care for patients who may not have access to high-volume care centers.
Senior researcher Henry Park ’07 MED ’12 presented his team’s findings on Sept. 26 at the annual American Society for Radiation Oncology (ASTRO) meeting in Boston, where he received the Resident Poster Viewing Recognition Award.
According to the ASTRO website, the award Park received was intended to “recognize the highest-rated abstracts submitted by residents and accepted as a paper poster.” It was awarded to just two other residents in the category of clinical practice.
The team’s abstract was first judged upon submission by a blind peer-review process and received one of the highest scores in its category. Then, a panel of researchers met to determine the award winners out of the top scoring abstracts and chose Park’s team and two others in the category of clinical practice, ASTRO Media Relations Manager Liz Gardner said.
The study, which used a free national cancer-statistics database provided by the American Cancer Society, looked at a sample size of 9,817 head and neck cancer patients and tracked both duration of radiation therapy and survival.
“We observed that patients treated at higher-volume centers achieved superior outcomes than those at lower-volume centers,” Park said. “We also found that shorter treatment duration was associated with higher-volume centers and associated with improved survival as well.”
On average, the team found that patients treated at higher case-volume facilities had a shorter stay by three days and that twice as many patients in lower case-volume facilities had what the team deemed an extended treatment break — a treatment period that was significantly longer than a typical one for head and neck cancer.
All the patients in the study had been treated with intensity-modulated radiation therapy, a breakthrough technology that allows for more nuance, control and ease than previous methods, Park said.
Previous studies had found a correlation between higher survival rates and increased case volume in head and neck cancers when 3D conformal radiation therapy — a less advanced technology — was used, but that relationship had yet to be established between survival rates and IMRT, according to the team’s abstract.
“It’s important to see if IMRT in the context of this question was something that might level the playing field because it’s such a new technology,” said Jeff Buchsbaum, medical officer and program director of the National Cancer Institute’s Radiation Research Program.
He compared the advantages of IMRT to driving an automatic-transmission racing car instead of a stick-shift vehicle. If everyone has this technology, one might think that they would see a similar level of performance across the board. However, this research shows “that it’s not as simple as everyone having the same fancy computer system or the same program,” he said.
Park’s team’s conclusions were not independent findings within the field of oncology — papers published on stage 3 lung cancer, pancreatic cancer and cervical cancer have all reached similar conclusions, he said.
This kind of observation has been around for quite some time, and it raises concerns about what happens to patients who might not have access to higher-volume facilities, Buchsbaum added.
The question her and others must now address is “how can our society, how can people like me at the National Cancer Institute make it more even for everybody,” he added.
“You can do all these operation-based studies, but what do I do about the patient who comes to my office and asks me, ‘Doc, do you think I should stay here or could I go closer to home to get my treatment?’” Park said. “I think that’s a question that we still don’t really know the answer to.”
Although the team’s conclusions were not novel, they contributed important data and their statistical methodology was robust, Buchsbaum said. While he commended the study’s large sample size, he said he wished the researchers could have conducted a prospective study to avoid possible biases.
Park also cited problems with the database the researchers used, which limited them to annual rather than cumulative statistics for case volume per provider and omitted relevant patent information such as side effects and comorbidities — linked diseases.
Although there are gaps in the study’s data, Park hopes that his team’s research proves to be hypothesis-generating. He and his colleagues are currently writing up the research for formal publication, he said.