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The impact of institutional clinical trial recruitment versus hospital volume on survival outcomes of patients with head and neck cancer: An analysis of the PET-NECK trial outcomes, UKCRN portfolio, and Hospital Episode Statistics (HES) in England

Lookup NU author(s): Dr Daniel Lin


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© 2018 Elsevier Ltd Objectives: High institutional clinical trial recruitment and high hospital volume are reported to be independent indicators of better patient outcomes following cancer treatment. However, their relationship in head and neck cancers (HNC) remains less clear. Methods: We aimed to assess the relationship between institutional clinical trial recruitment, hospital throughput of HNC cases, and survival of patients with advanced HNC treated with primary chemoradiotherapy at hospitals which recruited to the PET-NECK trial (2008–2012). The impact on outcome was assessed using Cox's proportional hazards regression analysis and multivariate analysis. Results: HNC RCT recruitment positively correlated with hospital throughput (r = 0.57, p < 0.0001). Low-recruiters (1–5 patients) had a 107% increased risk of death when compared to high-recruiters (>5 patients) (HR = 2.07, p = 0.05). There was no significant impact of hospital throughput on overall or disease-specific HNC survival. Multivariate analysis identified p16 status, N-stage, smoking, and RCT recruitment volume as the only significant predictors of survival. There was a significant difference in chemotherapy regimen between low and high-recruiters (p = 0.003) where a higher proportion of patients (50%, n = 13) in low-recruiting compared to high-recruiting hospitals (29%, n = 92) received neoadjuvant chemotherapy. A higher proportion of these patients died at low-recruiting hospitals (46% versus 23%). Discussion: A significant association exists between high recruitment and better OS for patients with HNC. However, no significance was found between hospital throughput and outcomes. The significance of individual centre differences in chemotherapy regimen needs further investigation. Future studies need a greater number of patient outcome events to support the trends found in this study.

Publication metadata

Author(s): Lin DJ, McConkey CC, Nankivell P, Dunn J, Mehanna H

Publication type: Article

Publication status: Published

Journal: Oral Oncology

Year: 2018

Volume: 85

Pages: 40-43

Print publication date: 01/10/2018

Online publication date: 21/08/2018

Acceptance date: 08/08/2018

ISSN (print): 1368-8375

ISSN (electronic): 1879-0593

Publisher: Elsevier Ltd


DOI: 10.1016/j.oraloncology.2018.08.006


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