The Current State of Regionalization in Otolaryngologic Specialized Tumor Care for Tumor Diagnoses

Abstract

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.