U.S. quality of care for head and neck cancers varies widely

The quality of care received by patients with head and neck cancers in the U.S. varies widely and is unaffected by the size of the hospital or the volume of patients treated in a year, a study shows.

Researchers studying the records of patients treated at 770 hospitals found wide variations in quality of care no matter whether facilities were teaching hospitals or community hospitals.

"There was pretty significant variation in quality within even academic medical centers and free-standing cancer centers, said study coauthor Dr. Umamaheswar Duvvuri, an assistant professor in the department of otolaryngology, head and neck surgery and director of robotic surgery at the University of Pittsburgh Medical Center. "We looked at factors such as getting all the cancer removed (during surgery) and taking out enough lymph nodes."

As reported in JAMA Otolaryngology–Head & Neck Surgery, Duvvuri and his colleagues had access to data from the National Cancer Database on 72,322 patients treated from 2004 through 2014.

The researchers looked at five benchmark factors: negative surgical margins (indicating that all of the cancer at that location was removed), lymph node removal that involved at least 18 nodes, appropriate use of radiation therapy, appropriate use of chemotherapy for patients with positive margins and an indication that those therapies occurred within six weeks post-surgery.

Hospitals were given scores depending on how well they hit the five benchmarks. The average overall quality score for all hospitals was 69.2 percent, with scores varying from a high of 90 percent to a low of 45 percent.

Scores varied widely no matter the type of hospital. Scores for academic hospitals, for example, varied from 48 percent to 82 percent, while those for community hospitals ranged from 48 percent to 89 percent.

Finding the hospital that will provide the best care is a challenge for all of us, said Dr. Abie Mendelsohn, an assistant professor-in-residence and director of head and neck robotic surgery at the David Geffen School of Medicine at the University of California, Los Angeles.

"There’s really no guide," said Mendelsohn, who was not involved with the new research. "The gold standard has been high volume centers. The idea is that you send all the patients with this one problem to one place and they will get better care. But there have been a number of papers suggesting that this may not be true."

The new study is "interesting," Mendelsohn said. "And it is provocative. But it asks more questions than it answers."

Ultimately, the study is telling us two things, Mendelsohn said. "The first goes to the health care community and says there is a lot of work to be done to make sure we’re maintaining excellence for our patients," he said. "We need to understand what the small hospitals are doing well and what the large hospitals are doing well."

"The second message is for patients: You can’t just trust the big name on the building," Mendelsohn said.

Duvvuri suggests questions for patients to ask. For example, "Do you practice in a multidisciplinary team?" "What is your positive margin rate?" "Is radiotherapy given in a timely fashion, according to guidelines?"

"You need to do your research," Mendelsohn said. "You need to know who will be the treating team because even in a large hospital there is variability between treating teams."

SOURCE: JAMA Otolaryngology–Head & Neck Surgery, online December 20, 2018.