## 1 Introduction  
Head and neck cancers, a heterogenous group of cancers originating in the head and neck region, are strongly linked to risk factors such as tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. Oropharyngeal squamous cell carcinomas (OPSCC) are one of the most common head and neck cancers; however, HPV-associated OPSCCs denote a distinct subtype of oropharyngeal cancer with rising incidence compared to the smoking-associated counterpart [1,2]. It has been shown that HPV-associated OPSCC has better prognosis [3, 4, 5, 6, 7] and is less likely to have a second primary site [8], but the occurrence of distant metastases is not significantly different than HPV-negative cancer [7,9].  
Due to the association between OPSCC and HPV-mediated oncogenesis, the 8 th edition of the American Joint Committee on Cancer (AJCC) denoted specific staging criteria and standard treatment for HPV-associated OPSCC, as well as emphasized the importance of extranodal extension (ENE) when determining staging and treatment for patients [10]. Standard treatment generally includes a multimodality approach consisting of transoral robotic surgery (TORS) for early stages or resectable tumors, and radiation therapy with or without concurrent chemotherapy as adjuvant or definitive treatment depending on tumor (T) and nodal (N) disease or high-risk pathologic features such as ENE or carcinoma-involved margins. In the incurable recurrent or metastatic (R/M) OPSCC setting, systemic treatment options include immune checkpoint inhibitors plus or minus chemotherapy with platinum/5-fluorouracilcell depending on PD-L1 expression, and novel approaches in immunotherapy combinations and HPV vaccines are currently undergoing investigation [11,12].  
Cancer patient outcomes after treatment at academic versus satellite sites have been previously explored in esophageal cancer, soft tissue sarcoma, and laryngeal cancer, reporting a trend of improved survival for patients treated at high-volume teaching facilities [13, 14, 15]. In choosing their treatment center, patients have to account for the geographical location, financial cost, and insurance-approved providers, which can greatly limit their options. Previous studies have examined head and neck cancer outcomes in patients treated at academic centers versus community sites with controversial results [16, 17, 18]. Currently, academic center and community clinic affiliations have increased to allow patients to have access to high quality and standardized care. However, outcomes analysis has not been studied in partnered academic and satellite sites operating under the same umbrella.  
At our institution, City of Hope (COH) Comprehensive Cancer Center, we have established various satellite sites distributed throughout the Southern California region in order to accommodate geographic restrictions and traffic limitations for our patients. Due to the complex nature of treating head and neck cancers, the coordination of various treatments and providers requires precise and effective medical practice. Functional and survival outcomes are dependent on the timing of adjuvant or definitive treatment as well as dedicated follow-up of patients with adequate supportive service such as speech pathology, nutrition specialists, and physical and occupational therapy. Several quality assurance measures are in place at COH, including reviews of satellite site radiation treatment plans performed at the main campus prior to treatment start.  
We designed a retrospective study to analyze and compare survival and functional outcomes in patients treated at COH's main campus versus selected satellite sites with COH-associated faculty and radiation therapy facilities.