Increasing Proportion of Head and Neck Cancer Patients Treated at Teaching Hospitals
In a study reported in JAMA Otolaryngology Head & Neck Surgery, Neil Bhattacharyya, MD, of Brigham and Women’s Hospital and Harvard Medical School, and Elliot Abemayor, MD, PhD, of David Geffen School of Medicine at UCLA, analyzed recent patterns of hospitalization for head and neck cancer. They found that treatment of head and neck cancer is increasingly regionalized to teaching hospitals.
Study Details
The study involved data from all inpatient admissions with a primary head and neck cancer diagnosis in the Nationwide Inpatient Sample during 2000, 2005, and 2010. The distributions of admissions according to hospital teaching status, hospital bed size, and primary payer were compared by year.
Based on the raw data from the Nationwide Inpatient Sample, the estimated nationally weighted number of inpatient hospital head and neck cancer stays in the United States was 28,862 (unweighted, 5,869) in 2000, 33,517 (unweighted, 6,759) in 2005, and 37,354 (unweighted, 7,371) in 2010. The most common cancer sites were supraglottis (weighted, n = 1,792), tongue base (n = 1,751), parotid (n = 1,205), larynx–not otherwise specified (n = 1,181), and tonsil (n = 1,118).
Increased Use of Teaching Hospitals
From 2000 to 2005 and 2010, the percentage of admissions to teaching hospitals increased from 61.7% to 64.2% and 79.8% (P < .001 vs nonteaching hospitals). On multivariate analysis adjusting for hospital region, hospital bed size, and expected source of payment, odds ratios for admission to a teaching hospital were 1.1 (95% confidence interval [CI] = 0.7–1.7) for 2005 vs 2000 and 2.5 (95% CI = 1.6–3.7, P < .001) for 2010 vs 2000.
Hospital Size and Payer Patterns
The percentage of admissions to large–bed-size hospitals also increased from 69.2% to 71.4% and 73.3%, although no significant difference was observed in change according to bed size (P = .36); percentage of admissions to medium–bed-size hospitals decreased from 23.4% to 19.0% and 14.9%, and percentage of admissions to small–bed-size hospitals increased from 7.4% to 9.6% and 11.8%. The primary payer distribution also did not change significantly (P = .82). For 2000, 2005, and 2010, the primary payer was Medicare for 39.0%, 37.3%, and 39.6% of cases; Medicaid for 16.6%, 15.3%, and 17.4%; private insurance for 35.4%, 35.6%, and 33.3%; and other for 8.9%, 11.9%, and 9.7%.
For nonteaching hospitals, the primary payer was Medicare and Medicaid in 51.7% and 10.3% of admissions in 2000 and 46.4% and 15.9% in 2010. For teaching hospitals, the primary payer was Medicare and Medicaid in 39.0% and 16.6% in 2000 and 39.6% and 17.4% in 2010. Overall, there was no significant difference in payer distribution between teaching and nonteaching hospitals (P = .07).
The authors concluded, “Head and neck oncologic care is increasingly being regionalized to teaching hospitals and academic centers. Such regionalization also has important implications for future education of residents and measures of achieved competency.”
They added that “[r]egionalization of head and neck cancer care to teaching institutions is likely to offer significant individual patient and societal benefit,” noting that teaching hospitals are more likely to have the necessary support staff and to be familiar with recovery from complicated surgical procedures. In addition, these institutions are more likely to have a high volume of less common head and neck procedures, with the anticipated net result of such an increase in volume being improved quality and outcomes.
Dr. Abemayor is the corresponding author for the JAMA Otolaryngology Head & Neck Surgery article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
