Highlights
- •Half of the Belgian hospitals treated four or less eligible HNSCC patients per year.
- •Survival was significantly better for patients treated in higher volume centres.
- •The care for patients with HNSCC should be concentrated in reference centres.
Abstract
Objectives
The study investigated the association between hospital volume and observed survival
of patients with a head and neck squamous cell carcinoma (HNSCC).
Methods
Overall, 9245 patients diagnosed with HNSCC between 2009 and 2014, were identified
in the population-based Belgian Cancer Registry. This database was coupled with other
databases providing information on diagnostic and therapeutic procedures, vital status,
and comorbidities. The overall and relative survival probabilities were estimated
using the Kaplan-Meier and the Ederer II methods, respectively. The relation between
hospital volume and observed survival since diagnosis was then assessed using Cox
proportional hazard models adjusted for potential confounders.
Results
The care for patients with HNSCC in Belgium was dispersed over more than 99 centres
with half of the centres treating four or less patients with HNSCC per year. Survival
probabilities were significantly better for patients treated in higher volume centres
(>20 patients/year): the median survival of patients treated in these centres was
1.1 year longer (5.1 versus 4.0 years) than in lower volume centres. This association
was confirmed in analyses taking the case-mix between hospitals into account: the
hazard to die of any cause decreased on average with 0.4% per increase of one additionally
treated patient. Beyond 20 assigned patients per year, there was no further decrease
in the hazard to die.
Conclusions
Statistically significant and clinically relevant improved survival probabilities
were obtained in patients treated in higher volume centres (>20 patients/year) compared
with their peers treated in lower volume centres. This supports the recommendation
to concentrate the care for patients with HNSCC in reference centres.
Keywords
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Article info
Publication history
Published online: March 13, 2020
Accepted:
January 17,
2020
Received in revised form:
December 11,
2019
Received:
October 2,
2019
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
