Is There a Difference in Staging and Treatment of Head and Neck Squamous Cell Tumors Between Tertiary Care and Community-Based Institutions?

Abstract

Objective: To characterize the differences in the staging and treatment of patients with head and neck squamous cell carcinoma between a tertiary care center and community-based practices. Methods: This study is a retrospective chart review of 943 adult patients with head and neck squamous cell cancer presenting to a tertiary care center between 2008 and 2014 as part of the University of Michigan Head and Neck Cancer Specialized Program of Research Excellence (UM HN-SPORE) database. Demographic information, diagnostic testing, staging information, and treatment recommendations were recorded. Results: Of 943 patients reviewed, 159 had documentation of tumor stage that was assigned by the community-based practice. Of these, 53% had a tumor staging change made at the tertiary care center, with 43% of patients upstaged and 10% of patients downstaged. Fifty-one percent received different treatment than had previously been offered at the community-based practice, although only 31% of these patients had a change in tumor staging. Conclusion: Over half of patients with head and neck squamous cell carcinoma who are evaluated at a tertiary care center after the initial evaluation at a community-based practice have their tumors staged differently, with the majority upstaged. A significant number of these patients also received different treatment than was initially offered at the referring practice. Future studies are required to determine whether these differences have an effect on tumor recurrence and patient survival rates. Level of Evidence: 2c (Outcomes Research).