Patients With Oropharyngeal Cancer Have Worse OS When Treated at Community Centers

Patients with human papillomavirus (HPV)-related oropharyngeal cancer are increasingly being treated at community cancer centers, but patients treated at these centers tend to have worse overall survival (OS) than those treated at academic centers, according to research published in the Journal of the National Cancer Institute.

For this study, researchers evaluated data from 20,298 patients from the US National Cancer Database who were diagnosed with HPV-related oropharyngeal squamous cell carcinoma between 2010 and 2019.

A total of 13,672 patients (67.4%) were treated in an academic setting, and 6626 (32.6%) were treated in a community setting. The proportion of patients treated at community centers significantly increased over time, from 23.5% in 2010 to 35.9% in 2019 (P <.01).

“This trend toward increased treatment at community cancer centers was primarily for nonsurgical cases,” the researchers noted.

The proportion of all patients who received nonsurgical treatment increased from 62.1% to 73.7% over the period studied (P <.01), but this increase was primarily seen at community cancer centers. There was a 10.2% increase in nonsurgical treatment at community centers (P <.01), while the proportion of patients who received nonsurgical treatment at academic cancer centers remained stable.

In an unadjusted analysis, patients treated at community cancer centers were significantly more likely to undergo nonsurgical treatment than patients treated at academic centers (odds ratio [OR], 2.77; 95% CI, 2.57-2.98). This association was seen in an adjusted analysis as well (adjusted OR, 1.20; 95% CI, 1.18-1.22).

Survival data were available for 14,294 patients. The data showed that patients treated at community centers had a lower 4-year OS rate than those treated at academic centers — 82.5% and 86.9%, respectively.

Receiving treatment at a community cancer center (hazard ratio [HR], 1.40; 95% CI, 1.30-1.50) and receiving nonsurgical treatment (HR, 1.90; 95% CI, 1.75-2.07) were both associated with worse OS. The association between worse OS and treatment at community centers was seen in an adjusted analysis as well (adjusted HR, 1.19; 95% CI, 1.09-1.31).

An adjusted analysis also showed that receiving treatment at a community cancer center was associated with worse OS among patients who were not treated with surgery (adjusted HR, 1.22; 95% CI, 1.11-1.34), but there was no association between community cancer center treatment and worse OS for patients who were treated with surgery (adjusted HR, 1.20; 95% CI, 0.89-1.62).

“Treatment of HPV-related oropharyngeal squamous cell carcinoma has recently shifted to community cancer centers, with an increase in the proportion of nonsurgical treatment and worse overall survival at these centers compared with academic cancer centers,” the researchers summarized. “Concentration of care for HPV-related oropharyngeal squamous cell carcinoma at academic cancer centers and dedicated head and neck cancer centers may increase access to all available treatment modalities and improve survival.”

This article originally appeared on Cancer Therapy Advisor