Date of Award

January 2017

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Saral Mehra

Abstract

Background and Purpose: To determine the availability of outcomes data to head and neck cancer patients. To create a database of comprehensive information including demographics, process metrics, and outcomes for head and neck cancer patients who were diagnosed or treated at a Yale New Haven Hospital affiliate. To examine factors affecting functional and patient reported outcomes in patients with oropharyngeal cancers.

Materials and Methods: The websites of all NCI-designated Cancer Centers and all affiliated institutions were examined for publicly available data regarding head and neck cancer patients. For Yale data, IRB approval was obtained to use tumor registry data, as well as chart review, to create a comprehensive database for all new head and neck cancer patients at Yale in 2013 and 2014. The patients with oropharyngeal cancers were then isolated and all living patients were called to survey them about long term treatment effects, using a standardized survey. The data gathered was then analyzed using univariate and multivariate analysis.

Results: Only 6 institutions across the country had any publicly available data regarding head and neck patients, and only three of them had information beyond the number of patients seen. The database of head and neck cancer patients at Yale was created successfully, and compiled into outcomes books for each year that presented the relevant data. Analysis of oropharyngeal patients focused on HPV status, insurance type, academic vs. non-academic centers, and distance from radiation treatment site for patients treated with that modality. Many factors were found to be significant on univariate analysis. On multivariate analysis, it was found that HPV positive patients had better outcomes in various functional and patient reported outcomes. It was also found that private practice patients had improved outcomes compared to Medicare patients. Finally, it was also found that recurrence rates were higher for patients that lived over 15 miles away from their treatment site.

Conclusions: There is a paucity of publicly available data regarding head and neck cancer outcomes at NCI designated cancer centers around the country. At Yale, the data showed that standard metrics are in line with national outcomes. The institution can improve significantly in terms of various process metrics, most specifically in terms of having various ancillary staff work with patients who are diagnosed or treated for a head or neck cancer. Analysis of oropharyngeal patients demonstrated that patients with HPV negative cancers need closer monitoring for various functional and patient reported outcomes. It also demonstrated that patients on Medicare need monitoring for various other functional and patient reported metrics. Patients who live further from their treatment sites have higher recurrence rates, indicating that patients who have to travel further might be at higher risk for missing treatment or for receiving adequate follow-up.

Comments

This is an Open Access Thesis.

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