Board-certified facilities and survival in head and neck cancer in Japan: A hospital-based cancer registry study.
Head and neck cancer (HNC) outcomes may vary with facility specialization. Japan operates a nationwide board certification system that accredits training facilities based on case volume, multidisciplinary capacity, and specialist staffing. We examined whether treatment at certified facilities is associated with survival and assessed geographic variation in access to such facilities.
In this nationwide retrospective cohort study using the hospital-based cancer registry, we included 75,196 patients with primary invasive HNC diagnosed between 2012 and 2015 who received first-course treatment at board-certified (n = 48,674; 119 facilities) or non-certified (n = 26,522; 386 facilities) facilities. The primary outcome was 5-year overall survival, analysed using multilevel survival models with facility-level random effects adjusted for age and sex, stratified by stage (I-II vs III-IV) and subsite.
Board-certified facilities treated a higher proportion of patients with stage III-IV disease (55.2% vs 45.1%). For stage I-II disease, the 5-year survival was similar (76.7% vs 75.3%; adjusted hazard ratio [aHR], 0.99; 95% CI, 0.93-1.04). For stage III-IV disease, survival was higher at certified facilities (50.7% vs 44.9%; aHR, 0.86; 95% CI, 0.82-0.90). Stage-dependent associations were broadly consistent across subsites. The proportion of residents treated at certified facilities ranged from 9.7% to 91.9% across prefectures.
Treatment at board-certified facilities was associated with better survival for advanced but not early-stage HNC, suggesting specialization matters most for complex multimodality care. Substantial geographic variation in access represents a target for policy efforts aligning quality with equity.
In this nationwide retrospective cohort study using the hospital-based cancer registry, we included 75,196 patients with primary invasive HNC diagnosed between 2012 and 2015 who received first-course treatment at board-certified (n = 48,674; 119 facilities) or non-certified (n = 26,522; 386 facilities) facilities. The primary outcome was 5-year overall survival, analysed using multilevel survival models with facility-level random effects adjusted for age and sex, stratified by stage (I-II vs III-IV) and subsite.
Board-certified facilities treated a higher proportion of patients with stage III-IV disease (55.2% vs 45.1%). For stage I-II disease, the 5-year survival was similar (76.7% vs 75.3%; adjusted hazard ratio [aHR], 0.99; 95% CI, 0.93-1.04). For stage III-IV disease, survival was higher at certified facilities (50.7% vs 44.9%; aHR, 0.86; 95% CI, 0.82-0.90). Stage-dependent associations were broadly consistent across subsites. The proportion of residents treated at certified facilities ranged from 9.7% to 91.9% across prefectures.
Treatment at board-certified facilities was associated with better survival for advanced but not early-stage HNC, suggesting specialization matters most for complex multimodality care. Substantial geographic variation in access represents a target for policy efforts aligning quality with equity.