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The Case Volume Issue in Head and Neck Oncology

  • Salvatore Alfieri
  • Ester Orlandi
  • Paolo BossiEmail author
Head and Neck Cancer (L Licitra, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Head and Neck Cancer

Opinion statement

In the past few years, several evidences reported better outcomes, in terms of reduced toxicities and longer survival, for head and neck cancer (HNC) patients when “regionalized,” namely if they are managed at “high-volume” cancer referral centers (CRC). The benefit of case volume has been demonstrated in HNC patients primarily treated with surgery and in those receiving curative radiotherapy and chemotherapy. Many factors could explain these positive results: organization, facilities, processes of care, quality assurance programs, professional expertise, technology, and patient referral bias. In other words, the “high volume” could be linked both to all hospital-related volume and to the expertise of each involved professional figure (e.g., surgeon, radiation oncologist, medical oncologist, etc.). In this context, it is still debatable whether there is a need to understand which one of these factors is more able to influence the final outcomes of HNC patients. Considering the complexity and heterogeneity of HNC, all of these aspects are likely to impact and plot each other. However, there is no consensus regarding the criteria and the cut-off used to define as “high” the case volume. Moreover, some limitations or biases of the regionalization process have to be highlighted: (1) personal and financial discomfort of patients, their caregivers, and families; (2) a frequent referral of the healthiest or youngest patients to CRC could change the survival outcomes; (3) potential higher difficulties for colleagues working outside of CRC in the emergency. Nevertheless, the case volume represents one of the factors impacting on the quality of the treatment itself, in terms of reduced toxicity and better treatment outcome. Therefore, it should be considered as a stratifying factor in randomized controlled trials for HNC patients.

Keywords

Head and neck cancer Case volume Surgery Chemotherapy Radiation 

Notes

Compliance with Ethical Standards

Conflict of Interest

Salvatore Alfieri declares that he has no conflict of interest.

Ester Orlandi declares that she has no conflict of interest.

Paolo Bossi has received research support through grants from Merck Serono and Molteni and has received compensation from Merck Serono, AstraZeneca, Kyowa Kirin, Roche, Molteni, and Mundipharma for service as a consultant.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–37.CrossRefPubMedGoogle Scholar
  2. 2.
    • Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349(22):2117–27. This study assessed the hospital-related case volume, after adjusting for a surgeon case volume, as the strongest predictor of decreased mortality in few surgical procedures (lung and pancreatic resection, repair of an abdominal aortic aneurysm, and cystectomy). The need of a peri-operative long stay and the importance of all hospital-based services could reasonably explain such an influence from the hospital rather than the surgeon volume.CrossRefPubMedGoogle Scholar
  3. 3.
    Urbach DR, Bell CM, Austin PC. Differences in operative mortality between high- and low-volume hospitals in Ontario for 5 major surgical procedures: estimating the number of lives potentially saved through regionalization. Can Med Assoc J. 2003;168(11):1409–14.Google Scholar
  4. 4.
    Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA. 2000;283(9):1159–66.CrossRefPubMedGoogle Scholar
  5. 5.
    Birkmeyer JD, Lucas FL, Wennberg DE. Potential benefits of regionalizing major surgery in Medicare patients. Eff Clin Pract. 1999;2(6):277–83.PubMedGoogle Scholar
  6. 6.
    •• Eskander A, Merdad M, Irish JC, Hall SF, Groome PA, Freeman JL, et al. Volume-outcome associations in head and neck cancer treatment: a systematic review and meta-analysis. Head Neck. 2014;36(12):1820–34. This is a review and meta-analysis of all the studies investigating the relationship between the case volume (hospital and/or surgeon-related) and survival outcomes in the context of multimodality treatment of head and neck cancer patients.CrossRefPubMedGoogle Scholar
  7. 7.
    Cheung MC, Koniaris LG, Perez EA, Molina MA, Goodwin WJ, Salloum RM. Impact of hospital volume on surgical outcome for head and neck cancer. Ann Surg Oncol. 2009;16(4):1001–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Sharma A, Schwartz SM, Méndez E. Hospital volume is associated with survival but not multimodality therapy in Medicare patients with advanced head and neck cancer. Cancer. 2013;119(10):1845–52.CrossRefPubMedGoogle Scholar
  9. 9.
    Lee CC, Ho HC, Chou P. Multivariate analyses to assess the effect of surgeon volume on survival rate in oral cancer: a nationwide population-based study in Taiwan. Oral Oncol. 2010;46(4):271–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Lin CC, Lin HC. Effects of surgeon and hospital volume on 5-year survival rates following oral cancer resections: the experience of an Asian country. Surgery. 2008;143(3):343–51.CrossRefPubMedGoogle Scholar
  11. 11.
    Chen AY, Pavluck A, Halpern M, Ward E. Impact of treating facilities’ volume on survival for early-stage laryngeal cancer. Head Neck. 2009;31(9):113711–43.CrossRefGoogle Scholar
  12. 12.
    Chen AY, Fedewa S, Pavluck A, Ward EM. Improved survival is associated with treatment at high-volume teaching facilities for patients with advanced stage laryngeal cancer. Cancer. 2010;116(20):4744–52.CrossRefPubMedGoogle Scholar
  13. 13.
    •• Eskander A, Irish J, Groome PA, Freeman J, Gullane P, Gilbert R, et al. Volume-outcome relationships for head and neck cancer surgery in a universal health care system. Laryngoscope. 2014;124(9):2081–8. This was the first study confirming in head and neck cancer surgery the hospital volume as the significant and most robust predictor of better survival at multivariate analysis.CrossRefPubMedGoogle Scholar
  14. 14.
    Eskander A, Monteiro E, Irish J, Gullane P, Gilbert R, de Almeida J, et al. Adherence to guideline-recommended process measures for squamous cell carcinoma of the head and neck in Ontario: impact of surgeon and hospital volume. Head Neck. 2016;38(Suppl 1):E1987–92.CrossRefPubMedGoogle Scholar
  15. 15.
    Narang AK, Tran PT. Prostate cancer: case volume and improved outcomes across cancer care. Nat Rev Urol. 2016;13(4):186–7.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Vrijens F, Stordeur S, Beirens K, Devriese S, Van Eycken E, Vlayen J. Effect of hospital volume on processes of care and 5-year survival after breast cancer: a population-based study on 25000 women. Breast. 2012;21(3):261–6.CrossRefPubMedGoogle Scholar
  17. 17.
    • Peters LJ, O’Sullivan B, Giralt J, Fitzgerald TJ, Trotti A, Bernier J, et al. Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02. J Clin Oncol. 2010;28:2996–3001. Secondary analysis of the Trans-Tasman Radiation Oncology Group trial showing how non-compliant radiation plans were observed more frequently in low accruing sites; non-compliance was associated with reduced survival.CrossRefPubMedGoogle Scholar
  18. 18.
    World Health Organization (WHO). Quality Assurance in Radiotherapy. Geneva: WHO; 1998.Google Scholar
  19. 19.
    Rischin D, Peters L, O’Sullivan B, Giralt J, Fisher R, Yuen K, et al. Tirapazamine, cisplatin and radiation versus cisplatin and radiation for advanced squamous cell carcinoma of the head and neck (TROG 02.02, HeadSTART): a phase III trial of the Trans-Tasman Radiation Oncology Group. J Clin Oncol. 2010;28:2989–95.CrossRefPubMedGoogle Scholar
  20. 20.
    Eisbruch A, Harris J, Garden AS, Chao CK, Straube W, Harari PM, et al. Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Rad Oncol Biol Phys. 2010;76(5):1333–8.CrossRefGoogle Scholar
  21. 21.
    • Boero I, Paravati A, Xu B, Cohen EE, Mell LK, Le QT, et al. Importance of radiation oncologist experience among patients with head-and-neck cancer treated with intensity-modulated radiation therapy. J Clin Oncol. 2016;34(7):684–90. Analysis conducted on data from US individual cancer registries. Patients receiving IMRT and treated by high-volume providers showed a decrease in all-cause mortality and less toxicities, namely less aspiration pneumonia.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    •• Wuthrick EJ, Zhang Q, Machtay M, et al. Institutional clinical trial accrual volume and survival of patients with head and neck cancer. J Clin Oncol. 2015;33:156–64. Analysis of the single-center experience within the RTOG 0129 trial comparing accelerated RT with RT concurrent to cisplatin. As surrogate of expertise, the number of patients enrolled in previous RTOG trials was considered. High historical accruing centers showed the greater benefit in terms of overall survival.CrossRefPubMedGoogle Scholar
  23. 23.
    de Ridder M, Balm AJ, Baatenburg de Jong RJ, Terhaard CH, Takes RP, Slingerland M, et al. Variation in head and neck cancer care in the Netherlands: a retrospective cohort evaluation of incidence, treatment and outcome. Eur J Surg Oncol. 2017;43(8):1494–502.CrossRefPubMedGoogle Scholar
  24. 24.
    Lassig AA, Joseph AM, Lindgren BR, et al. The effect of treating institution on outcomes in head and neck cancer. Otolaryngol Head Neck Surg. 2012;147:1083–92.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kubicek GJ, Wang F, Reddy E, Shnayder Y, Cabrera CE, Girod DA. Importance of treatment institution in head and neck cancer radiotherapy. Otolaryngol Head Neck Surg. 2009;141(2):172–6.  https://doi.org/10.1016/j.otohns.2009.03.019.CrossRefPubMedGoogle Scholar
  26. 26.
    Park HSM, Rutter CE, Lester-Coll NH, Corso CD, Wang EH, Wilson LD, et al. Facility case volume and outcomes for intensity modulated radiation therapy in head and neck cancer. Int J Rad Oncol Biol Phys. 2016;96(Suppl2):E325.CrossRefGoogle Scholar
  27. 27.
    Chen MM, Roman SA, Yarbrough WG, Burtness BA, Sosa JA, Judson BL. Trends and variations in the use of adjuvant therapy for patients with head and neck cancer. Cancer. 2014;120(21):3353–60.CrossRefPubMedGoogle Scholar
  28. 28.
    Brunner M, Gore SM, Read RL, Alexander A, Mehta A, Elliot M, et al. Head and neck multidisciplinary team meetings: effect on patient management. Head Neck. 2015;37(7):1046–50.  https://doi.org/10.1002/hed.23709.CrossRefPubMedGoogle Scholar
  29. 29.
    Wheless SA, McKinney KA, Zanation AM. A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngol Head Neck Surg. 2010;143(5):650–4.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Bergamini C, Locati L, Bossi P, Granata R, Alfieri S, Resteghini C, et al. Does a multidisciplinary team approach in a tertiary referral centre impact on the initial management of head and neck cancer? Oral Oncol. 2016;54:54–7.  https://doi.org/10.1016/j.oraloncology.2016.01.001.CrossRefPubMedGoogle Scholar
  31. 31.
    Beswick DM, Vashi A, Song Y, Pham R, Holsinger FC, Rayl JD, et al. Consultation via telemedicine and access to operative care for patients with head and neck cancer in a veterans health administration population. Head Neck. 2016;38(6):925–9.  https://doi.org/10.1002/hed.24386.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Head and Neck Medical Oncology DepartmentFondazione IRCCS Istituto Nazionale TumoriMilanItaly
  2. 2.Radiation Oncology 2 DepartmentFondazione IRCCS Istituto Nazionale TumoriMilanItaly

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