# The effects of certification of head and neck cancer centers on the survival of patients with a head and neck cancer

## TL;DR

This study finds that patients with head and neck cancer treated at certified centers have better survival outcomes compared to those treated at non-certified facilities.

## Contribution

The study provides empirical evidence that certification of cancer centers is associated with improved patient survival in head and neck cancer.

## Key findings

- Patients treated at certified centers had a significantly lower risk of death compared to those at non-certified centers.
- Certified centers showed a more pronounced benefit in recurrence-free survival.
- The survival advantage was observed in both statutory health insurance and cancer registry data.

## Abstract

Head and neck cancers represent a heterogeneous group of tumor in terms of both, their entity and location. This includes cancers of the lip, oral cavitiy, pharynx (epi-, oro- and hypopharynx), larynx, nasal cavity/ sinus and salivary gland. Additionally, they are associated with functional impairments that place highly specific demands on treating practitioners. Since the introduction of the German National Cancer Plan in 2008, cancer treatment has been aligned with the latest scientific findings through evidence-based guidelines. Meanwhile, treatment courses and outcomes have been systematically recorded by expanding the German cancer registry. In addition, the certification of treatment centers aims to ensure consistently high-quality care. Given the considerable investment of time, personnel, and financial resources required for certification, the question arises whether patients with head and neck cancer benefit from receiving (initial) treatment at a certified center compared to a non-certified facility.

We used patient-specific information from statutory health insurance (SHI) and clinical cancer registry (CCR) data for the period 2009–2017 as well as hospital characteristics from standardized quality reports. We applied multivariable Cox regressions to analyze differences in survival between patients treated in hospitals with and without German Cancer Society (DKG) certification.

The sample comprised 52,749 (SHI) and 15,287 (CCR) patients with head and neck cancer who were treated in 872 hospitals (44 DKG-certified, 828 not DKG-certified). 15.5% (SHI) and 25.9% (CCR) of patients were (initially) treated in DKG-certified cancer centers. Cox regression analysis for overall survival showed that patients treated in DKG-certified cancer centers were at significantly lower risk of death (SHI data: HR = 0.94, 95% CI = 0.89–1.00, p = 0.043; CCR data: HR = 0.89, 95% CI = 0.83–0.95, p < 0.001). Notably, the difference was even more pronounced for recurrence-free survival (CCR data: HR = 0.81, 95% CI = 0.72–0.92, p = 0.001).

Although achieving certification requires a substantial investment of personnel, time, and financial resources by the treating institution, it is associated with a measurable survival advantage for patients. Therefore, treatment of head and neck cancer patients should preferably be provided at certified head and neck cancer centers.

The online version contains supplementary material available at 10.1186/s12885-026-15624-z.