Impact of facility volume on overall survival among patients with skin cancer undergoing palliative treatment

Abstract

Treatment at high-volume facilities (HVFs) has been associated with improved survival of patients with skin cancer undergoing curative treatment. The influence of facility volume on overall survival (OS) in such patients undergoing palliative treatment is unknown. To investigate the impact of facility volume on OS in patients with skin cancer undergoing palliative treatment, the 2004 to 2018 National Cancer Database was queried for patients with skin cancer undergoing palliative treatment (N = 5,510). Patients were stratified based on facility volume percentile. Multivariable binary logistic and Cox proportional hazards regression models were implemented. Of 909 facilities, 464 (51.0%), 217 (23.9%), 127 (14.0%), 67 (7.4%), and 34 (3.7%) had volume < 20th, 20-40th, 40-60th, 60-80th, and ≥ 80th percentiles, respectively. Patients with Medicaid (aHR 0.54, 95% CI 0.38–0.76, P < 0.001), a Charlson-Deyo comorbidity score of 1 (aHR 0.68, 95% CI 0.53–0.88, P = 0.003), receiving palliative radiotherapy alone (aHR 0.70, 95% CI 0.51–0.96, P = 0.027), and a tumor stage > 1 were less likely to receive palliative treatment at a facility with volume ≥ 80th percentile. 5-year OS of patients undergoing palliative therapy at facilities with volume < 20th, 20-40th, 40-60th, 60-80th, and ≥ 80th percentile was 9%, 8%, 11%, 12%, and 20%, respectively (P < 0.001). Facilities with volume ≥ 70th percentile were associated with higher 5-year OS (P < 0.001). Undergoing palliative treatment at HVFs is associated with higher OS in patients with skin cancer. The survival benefit derived from HVFs should be contextualized with other patient and facility factors affecting access of palliative services. Level of Evidence: 4