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The Current State of Regionalization in Otolaryngologic Specialized Tumor Care for Tumor Diagnoses
Sina J Torabi1, Theodore V Nguyen, Khodayar Goshtasbi
1Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA.
Objective:
The current extent of otolaryngologic cancer care regionalization is unclear. This study characterizes case volume regionalization patterns for 4 distinct otolaryngologic tumors-head and neck squamous cell carcinomas (HNSCCs), thyroid cancers (TCs), vestibular schwannomas, and pituitary adenomas (PAs).
Methods:
The 2010-2016 National Cancer Database was queried for patients with HNSCCs, TCs, vestibular schwannomas, and PAs. Facility geographic locations were divided into 4 geographical quadrants. High-volume facilities (HVFs) were defined as top 100 by volume facility for ≥1 pathology.
Results:
A total of 191/1342 facilities (4.2%) were defined as an HVF. Vestibular schwannoma was the most regionalized, with 65.9% of patients treated at an HVF. Thyroid cancer (37.4%) and HNSCC (38.8%) were the least commonly treated at HVFs. Forty-one/191 (21.5%) were classified as HVFs for all 4 pathologies. Factors predictive of treatment at HVFs included age <65, higher income, and private insurance, larger tumor size, and lower American Joint Committee on Cancer stage.
Conclusion:
Over 20% of HVFs were considered high-volume for all 4 pathologies. Vestibular schwannomas were the most regionalized compared with PAs, TCs, and HSNCCs.
