Study Raises Questions About Outcomes and Trends in Head and Neck Cancer Care

A study in the Journal of the National Cancer Institute concluded that care for patients with human papillomavirus (HPV)-related squamous cell cancers of the oropharynx (an area in the back of the throat) is shifting toward community cancer centers, yet patients treated in that setting are less likely to survive, according to new research from the Johns Hopkins Kimmel Cancer Center.

The study indicates that the quality of care outside of academic medical centers for these patients is less likely to adhere to national best practices. Patients at community cancer centers are “less likely to receive care such as surgery” that is recommended by national guidelines and “more likely to receive radiation as a primary treatment.” Patients’ outcomes suffer when treated this way.

Carole Fakhry, M.D., M.P.H., director of the Johns Hopkins Head and Neck Cancer Center and the senior study author, writes that “the site of care determines patient outcomes and may influence the therapy landscape and survival for those rare head and neck cancer patients in the future.”

HPV-related tumors in the oropharynx, which consists of structures in the back of the throat (e.g. the base of the tongue, tonsils, and soft palate) are caused by HPV, which is the most common sexually transmitted infection in the U.S. Annually, around 15,000 new cases of oropharyngeal cancer in the U.S. are diagnosed each year, and the majority of those patients are HPV-positive.

The study uses data from over 20,000 patients who suffered from these types of cancers and underwent treatment between 2010 and 2019. A majority – about two-thirds – of patients still received care at academic cancer centers. The percentage of patients who seek care at community cancer centers rose from 24% in 2010 to 36% in 2019. Fakhry writes that it is possible that growing comfort levels among clinicians at these centers in dealing with these types of cancers could be attributable to the changing trend, but that rising comfort level has not translated to equivalent survival rates at community cancer centers versus academic ones. The number of patients who received nonsurgical treatment increased from 62% to 74% over the study period, which is consistent with the growing trend of people seeking treatment at community care centers, which tend to prioritize nonsurgical intervention.

During the first four years of the study, survival rates were similar between community cancer centers and academic ones. Between 2014 and 2017, however, the rates began to diverge, as 87% of patients treated at academic cancer centers survived versus 81% of those treated at community cancer centers. Danielle Trakimas, M.D., lead study author and otolaryngology resident at The Johns Hopkins Hospital, added that “if radiation is the primary modality of the future in community centers, there may be a greater need for radiation oncologists and the multidisciplinary team.” The trend from academic cancer centers toward community cancer centers, then, significantly impacts the need for different types of specialists to meet demand.

In addition, the study bolsters evidence that “higher-volume treatment centers have better outcomes than lower-volume ones.” Fakhry, the study author, adds that the study results “[raise] the question of whether we should focus care for HPV-related oropharyngeal squamous cell carcinomas at high-volume academic centers to optimize care.”

Johns Hopkins Medicine has the story.