ORIGINAL ARTICLE IMPACT OF TREATING FACILITIES’ VOLUME ON SURVIVAL FOR EARLY-STAGE LARYNGEAL CANCER Amy Y. Chen, MD, MPH, 1,2 Alex Pavluck, MPH, 2 Michael Halpern, MD, PhD, 2 * Elizabeth Ward, PhD 2 1 Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia. E-mail: achen@emory.edu 2 Department of Surveillance and Health Policy, American Cancer Society, Atlanta, Georgia Accepted 30 October 2008 Published online 1 April 2009 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.21072 Abstract: Background. Treatment at a high-volume facility has been associated with better outcomes in a variety of con- ditions. The relationship between volume and survival from la- ryngeal cancer has not been examined previously. Methods. A total of 11,446 early-stage laryngeal cancer patients (1996–1998) who reported to the National Cancer Database (NCDB) were analyzed. Proportional hazards regres- sion was used to assess the relationship between survival and treatment volume controlling for other factors associated with survival. Results. Treatment at low-volume facilities was associated with a significantly increased likelihood of death (hazard ratio 1.20, 95% CI 1.04–1.38). Surgical resection, as compared with radiation treatment, was associated with lower mortality (HR 0.74, 95% CI 0.69–0.80). Conclusion. This study is the first to assess the relationship between survival and treatment volume in laryngeal cancer. Treatment at a high-volume facility is associated with better survival. Surgical treatment rather than radiation was also asso- ciated with better survival, although we could not control for confounders that may bias treatment selection. V V C 2009 Wiley Periodicals, Inc. Head Neck 31: 1137–1143, 2009 Keywords: quality of care; laryngeal cancer; surgery; radiation; disparities In 2008, laryngeal cancer will be diagnosed in 12,250 men and women in the United States and is among the most common cancers of the upper aerodigestive tract. 1 Appropriate treatment for early-stage laryngeal cancer (T1 or T2) consists of either partial laryngectomy or radiation. 2 Numerous studies have examined the associa- tion between the volume of cases a hospital or provider treats and clinical outcomes, particu- larly for heart disease and cancer. 3–8 Many stud- ies have focused on surgical volumes (either at the surgeon or facility level). However, as the treatment of head and neck cancer is increas- ingly multidisciplinary, and early-stage laryn- geal cancer may be effectively treated by surgery or radiation therapy, in this study, we sought to evaluate the relationship between total treat- ment volume and outcome of treatment (survival in the first 5 years after treatment). Correspondence to: A. Y. Chen Presented at 7th International Conference on Head and Neck Cancer, San Francisco, California, July 20, 2008. *Current address: Department of Health Services and Social Policy Research, RTI International, Washington, DC. V V C 2009 Wiley Periodicals, Inc. Treatment Volume and Survival in Laryngeal Cancer HEAD & NECK—DOI 10.1002/hed September 2009 1137