Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Objective: National Cancer Institute (NCI)-designated cancer centers provide greater access to evidence-based medicine and high-quality care. Current literature demonstrates that patients who undergo treatment at an NCI-designated cancer center have better survival outcomes compared to patients who undergo treatment at a non-NCI center. However, the impact of treatment setting on patient-reported outcome measures (PROMs) is underreported. This analysis aims to evaluate the impact of radiation treatment center setting on PROMs among head and neck cancer (HNC) survivors.
Methods: Survivors with squamous cell carcinoma (SCC) of the oral cavity, oropharynx, larynx, and other sites, who underwent radiation treatment at an NCI-designated cancer center or a non-NCI center, and who completed validated PROMs in our HNC survivorship clinic between 2017 and 2022 were included. Survivors with recurrence, second primary, and/or distant metastasis were excluded. Sociodemographic and clinical data were collected. PROMs, including the University of Washington Quality of Life (UWQOL), Neck Disability Index (NDI), Eating Assessment Tool-10 (EAT-10), Insomnia Severity Index (ISI), Patient Health Questionnaire-8 (PHQ-8), and Generalized Anxiety Disorder-7 (GAD-7) were collected at one-year post-radiation. Higher UWQOL scores indicate better QOL. Higher NDI, EAT-10, and ISI scores indicate worse symptoms burden. Higher PHQ-8 and GAD-7 scores indicate worse psychological distress. Multiple linear regression analysis was used to detect the association between radiation treatment center setting and PROMs, while controlling for potential confounders.
Results: 310 patients were included in the analysis. 187 patients (60.3%) received radiation treatment at an NCI-designated cancer center and 123 patients (39.7%) received radiation treatment at a non-NCI center. Most patients were male (238, 76.8%) and White (278, 89.7%), with a mean (SD) age of 61.09 (9.58) years old. The majority had oropharyngeal (163, 52.6%) and oral cavity (64, 20.6%) SCC with tumor stage I/II (161, 51.9%) and nodal stage 0/I (159, 51.3%). Compared to patients treated at a non-NCI center, patients treated at an NCI center had significantly 4.65 points higher physical UWQOL (95% CI [1.00, 8.31], p=.013), 1.40 points lower PHQ-8 (95% CI [-2.49, -0.32], p=.012), 1.06 points lower GAD-7 (95% CI [-1.99, -0.12], p=.027), 4.21 points lower EAT-10 (95% CI [-6.67, -1.74], p<.001), and 2.08 points lower ISI (95% CI [-3.58, -0.59], p=.007) scores at one-year post-radiation. No significant difference was detected for social-emotional UWQOL and NDI scores.
Conclusion: Undergoing radiation treatment at an NCI-designated cancer center was associated with higher physical QOL and lower symptoms burden and psychological distress among HNC survivors. These findings provide evidence of improvements in outcomes with receiving radiation treatment at an NCI center from the patient perspective. Furthermore, these findings underscore the importance of ongoing efforts to increase access to NCI centers to promote high-quality care for all.