Does the type of facility affect outcomes in patients with Merkel cell carcinoma?

Treatment of Merkel cell carcinoma (MCC), a rare neuroendocrine skin cancer with high mortality and rising incidence, at either an academic or a high-volume centre tends to lead to better patient survival, as shown in a recent study.

A team of investigators carried out this retrospective cohort analysis to determine whether facility academic affiliation or case volume could influence survival in patients with MCC. Using the National Cancer Database, they identified US adults diagnosed with MCC from 2004 to 2014.

As a result, both facility academic affiliation (p<0.001) and case volume (p<0.001) showed a significant association with patient survival.

For those treated at academic facilities, the survival rate at 5 years was 63.0 percent (standard error [SE] 1.7), while that of a propensity score-matched cohort of patients treated at nonacademic facilities was 53.4 percent (SE 1.9).

Among those who received treatment at high-case volume facilities, the 5-year survival rate was 67.4 percent (SE 2.1), while that of a propensity score-matched cohort of patients treated at low- and intermediate-case volume facilities was 58.6 years (SE 2.0).

“Further studies evaluating comorbidities and disease-specific survival are needed to establish whether experienced centres have improved outcomes in MCC treatment,” the investigators said.

This study was limited by the absence of disease-specific survival and local recurrence data.

“Previous work has suggested that facility-level characteristics, such as case volume and academic affiliation, are associated with patient survival for rare malignancies,” the investigators noted.