Comparison of surgical margins and adjuvant therapy for head and neck cancer by hospital type.

Background: Differences in patient populations and outcomes by hospital type are becoming increasingly relevant as health care systems shift to value-based care models. There is a paucity of literature on patient-level and hospital-level differences for patients with head and neck squamous cell carcinoma (HNSCC). The objective of this study was to examine differences in patient characteristics, surgical margins, and adjuvant therapy patterns for surgically treated HNSCC across different hospital types.
Methods: A statewide retrospective cohort study was conducted to examine differences in surgically treated patients with HNSCC by hospital type.
Results: A total of 579 surgically treated HNSCC patients with a mean age of 58.5 [standard deviation (SD) 10.7] years were included. There were 152 patients (26%) treated at academic hospitals, 205 (35%) at community cancer centers, and 222 (38%) at community hospitals. Patients at academic hospitals were more likely to travel farther for surgery (mean distance 43.6 miles for academic centers vs. 12.7 miles for community cancer centers vs. 12.6 miles for community hospitals; P<0.001) and have advanced T stage (T3-T4) at diagnosis (38% academic, 26% community cancer center, 26% community hospital; P=0.003). There was no significant difference in the positive surgical margin rate by hospital type (32.0% for academic hospitals, 32.1% for community cancer centers, and 35.0% for community hospitals; P=0.79). However, patients at academic hospitals were more likely to receive adjuvant chemoradiation even after adjusting for tumor stage and site [odds ratio (OR) 2.4, 95% confidence interval (CI): 1.2-5.0].
Conclusions: There are important patient-level and hospital-level differences for head and neck cancer management in academic versus community hospitals.
Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tcr.amegroups.com/article/view/10.21037/tcr-23-2047/coif). J.T. serves as an unpaid editorial board member of Translational Cancer Research from May 2023 to April 2025. J.P.Z. is the founder, board member, and inventor on the majority of IP owned or licensed to Droplet Biosciences, which is not directly relevant to the work included in this manuscript. A.F.O. reports grants from University Cancer Research Fund (General support through the UNC Lineberger Comprehensive Cancer Center). A.M.Z. reports consulting fees from Johnson and Johnson, R and D consulting, payment to his consulting company, unrelated to this work or manuscript. W.G.Y. reports grant funding from NIH for research and payment for expert witness in legal cases. The other authors have no conflicts of interest to declare.
(2024 AME Publishing Company. All rights reserved.)