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Bateni SB, Gingrich AA, Hoch JS, Canter RJ, Bold RJ. Defining Value for Pancreatic Surgery in Early-Stage Pancreatic Cancer. JAMA Surg 2019; 154:e193019. [PMID: 31433465 PMCID: PMC6704743 DOI: 10.1001/jamasurg.2019.3019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/26/2019] [Indexed: 12/15/2022]
Abstract
Importance Value-based care is increasingly important, with rising health care costs and advances in cancer treatment leading to greater survival for patients with cancer. Regionalization of surgical care for pancreatic cancer has been extensively studied as a strategy to improve perioperative outcomes, but investigation of long-term outcomes relative to health care costs (ie, value) is lacking. Objective To identify patient and hospital characteristics associated with improved overall survival, decreased costs, and greater value among patients with pancreatic cancer undergoing curative resection. Design, Setting, and Participants This retrospective cohort study identified 2786 patients with stages I to II pancreatic cancer who underwent pancreatic resection at 157 hospitals from January 1, 2004, through December 31, 2012. The study used the California Cancer Registry, which collects data from all California residents newly diagnosed with cancer, linked to the Office of Statewide Health Planning and Development database, which collects administrative data from all California licensed hospitals. Data were analyzed from November 11, 2017, through September 4, 2018. Exposures Pancreatic resection at high-volume and/or National Cancer Institute (NCI)-designated cancer centers. Main Outcomes and Measures The primary outcomes were overall survival, surgical hospitalization costs, and value. High value was defined as the fourth quintile or higher for survival and the second quintile or less for costs. Costs were calculated from charges using cost-charge ratios and adjusted for geographic variation and inflation. Multivariable regression models were used to determine factors associated with overall survival, costs, and high value. Results Among the 2786 patients included (1394 [50.0%] male; mean [SD] age, 67.0 [10.7] years), postoperative chemotherapy (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.64-0.79; P < .001) and high-volume centers (aHR, 0.78; 95% CI, 0.61-0.99; P = .04) were associated with greater overall survival. Higher Elixhauser comorbidity index scores (estimate, 0.006; 95% CI, 0.003-0.008), complications (estimate, 0.22; 95% CI, 0.17-0.27), readmissions (estimate, 0.34; 95% CI, 0.29-0.39), and longer lengths of stay (estimate, 0.03; 95% CI, 0.03-0.04) were associated with higher costs (P < .001), whereas postoperative chemotherapy was associated with lower costs (estimate, -0.06; 95% CI, -0.11 to -0.02; P = .006). National Cancer Institute-designated and high-volume centers were not associated with costs. Although grades III and IV tumors (odds ratio [OR], 0.65; 95% CI, 0.39-0.91; P = .001), T3 category disease (OR, 0.71; 95% CI, 0.46-0.95; P = .005), complications (OR, 0.68; 95% CI, 0.49-0.86; P < .001), readmissions (OR, 0.64; 95% CI, 0.44-0.84; P < .001), and length of stay (OR, 0.82; 95% CI, 0.78-0.85; P < .001) were inversely associated with high-value care, NCI designation (OR, 1.07; 95% CI, 0.66-1.49; P = .74) and high-volume centers (OR, 1.08; 95% CI, 0.54-1.61; P = .07) were not. Conclusions and Relevance In this study, high-value care was associated with important patient characteristics and postoperative outcomes. However, NCI-designated and high-volume centers were not associated with greater value. These data suggest that targeted measures to enhance value may be needed in these centers.
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Affiliation(s)
- Sarah B. Bateni
- Divison of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento
| | - Alicia A. Gingrich
- Divison of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento
| | - Jeffrey S. Hoch
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
- Divison of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Medical Center, Sacramento
| | - Robert J. Canter
- Divison of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento
| | - Richard J. Bold
- Divison of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento
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Cheng D, Cross CL, Calfee G, Kirgan D, Williams SJ, Baynosa J, St Hill CR. Comparing treatment patterns of hepatocellular carcinoma at academic centers and non-academic centers within the Mountain Region. Am J Surg 2019; 218:1052-1059. [PMID: 31619375 DOI: 10.1016/j.amjsurg.2019.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 09/09/2019] [Accepted: 09/21/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Our objective is to explore differences in survival and treatment approaches for hepatocellular carcinoma (HCC) between academic centers (ACs) and non-academic centers (NACs), which may contribute to disparities in the Mountain Region (MR). METHODS Using the National Cancer Database, HCC cases from 2004 to 2015 in the MR were divided into AC and NAC subgroups. Cox-proportional hazard regression and binary logistic regression were performed to analyze survival, compare treatment patterns, and examine the effect of facility type and surgical approach on margin status. RESULTS Treatment at ACs, compared to NACs, is associated with improved survival. At ACs, the odds of surgical or systemic treatment were higher. The odds of receiving radiation and positive margins was lower. Overall, the odds of positive margins was higher with laparoscopic compared to open or an unspecified surgical approach; this relationship persisted on subgroup analysis of NACs, but not ACs. CONCLUSIONS Treatment of HCC at an AC in the MR increases the odds of surgery and improves survival. A laparoscopic approach increases the odds of positive margins, irrespective of center type.
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Affiliation(s)
- Daniel Cheng
- University of Nevada, Las Vegas, School of Medicine, USA.
| | - Chad L Cross
- University of Nevada, Las Vegas, School of Medicine, USA; University of Nevada, Las Vegas, School of Public Health, USA.
| | - Gregory Calfee
- University of Nevada, Las Vegas, School of Medicine, USA.
| | - Daniel Kirgan
- University of Nevada, Las Vegas, School of Medicine, USA.
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Malone H, Cloney M, Yang J, Hershman DL, Wright JD, Neugut AI, Bruce JN. Failure to Rescue and Mortality Following Resection of Intracranial Neoplasms. Neurosurgery 2019; 83:263-269. [PMID: 28973498 DOI: 10.1093/neuros/nyx354] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 06/05/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is growing recognition that perioperative complication rates are similar between hospitals, but mortality rates are lower at high-volume centers. This may be due to differences in the ability to rescue patients from major complications. OBJECTIVE To examine the relationship between hospital caseload and failure to rescue from complications following resection of intracranial neoplasms. METHODS We identified adults in the Nationwide Inpatient Sample diagnosed with glioma, meningioma, brain metastasis, or acoustic neuroma, who underwent surgical resection between 1998 and 2010. We stratified hospitals by low, intermediate, and high surgical volume tertiles and calculated failure to rescue rates (mortality in patients after a major complication). RESULTS A total of 550 054 patients were analyzed. Overall risk-adjusted complication rates were comparable between low- and medium-volume centers, and slightly lower at high-volume centers (15.3% [15.2, 15.5] vs 15.7% [15.5, 15.9] vs 14.3% [14.1, 14.6]). Risk-adjusted mortality decreased with increasing hospital surgical volume (10.3% [10.2, 10.5] vs 9.0% [8.9, 9.1] vs 7.1% [7.0, 7.2]). The overall risk-adjusted failure to rescue rate also decreased with increasing surgical volume (26.9% [26.3, 27.4] vs 24.8% [24.3, 25.3] vs 20.9% [20.5, 21.5]). CONCLUSION While complication rates were similar between high-volume and low-volume hospitals following craniotomy for tumor, mortality rates were substantially lower at high-volume centers. This appears to be due to the ability of high-volume hospitals to rescue patients from major perioperative complications.
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Affiliation(s)
- Hani Malone
- Department of Neurological Surgery, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York, New York
| | - Michael Cloney
- Department of Neurological Surgery, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York, New York
| | - Jingyan Yang
- Department of Epidemiology, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York, New York
| | - Dawn L Hershman
- Department of Epidemiology, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York, New York.,Department of Medicine, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York, New York
| | - Jason D Wright
- Department of Epidemiology, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York, New York.,Department of Obstetrics & Gynecology, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York, New York
| | - Alfred I Neugut
- Department of Epidemiology, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York, New York.,Department of Medicine, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York, New York
| | - Jeffrey N Bruce
- Department of Neurological Surgery, College of Physicians and Surgeons and the Mailman School of Public Health, Columbia University, New York, New York
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Spolverato G, Gennaro N, Zorzi M, Rugge M, Mescoli C, Saugo M, Corti MC, Pucciarelli S. Failure to rescue as a source of variation in hospital mortality after rectal surgery: The Italian experience. Eur J Surg Oncol 2019; 45:1219-1224. [DOI: 10.1016/j.ejso.2019.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/21/2019] [Accepted: 03/04/2019] [Indexed: 01/17/2023] Open
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Ely S, Alabaster A, Ashiku SK, Patel A, Velotta JB. Regionalization of thoracic surgery improves short-term cancer esophagectomy outcomes. J Thorac Dis 2019; 11:1867-1878. [PMID: 31285879 DOI: 10.21037/jtd.2019.05.30] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Some studies have found that outcomes from cancer esophagectomy are better at higher-volume centers than at lower-volume centers. Reports on outcomes following systematic centralization have largely demonstrated subsequent improvements, but these originate in nationalized healthcare systems that are not very comparable to the heterogeneous private-payer systems that predominate in the United States. We examined how regionalization of thoracic surgery to Centers of Excellence (CoE) within our American integrated healthcare system changed overall care for our patients, and whether it changed outcomes. Methods We conducted a retrospective chart review of 461 consecutive patients undergoing cancer esophagectomy between 2009-2016, spanning the 2014 shift to regionalization. High-volume was defined as ≥5 esophagectomies per year. We compared characteristics of the surgeon, hospital, and operation pre- and post-regionalization using Chi-square or Fisher's exact test for categorical variables and Kruskal-Wallis test for age. We evaluated their associations with patient outcomes with hierarchical linear and logistic mixed models, which adjusted for clustering within surgeon and facility levels and relevant covariates. Results While there was no difference in their baseline demographics, patients undergoing esophagectomy post-regionalization were much more likely to have their surgery performed at a designated Center of Excellence (78.8% of cases versus 34.2%, P<0.001), at a high-volume hospital (92.1% from 75.7%, P<0.001), by a high-volume surgeon (78.8% from 58.8%, P<0.001), by a board-certified thoracic surgeon (82.5% from 64.0%, P<0.001), and by minimally-invasive, versus open, approach (60.8% from 22.1%, P<0.001). Post-regionalization patients were in higher American Society of Anesthesiologists classes (P=0.03) and trended toward higher-stage disease (P=0.14), indicative of the inclusion of higher-complexity patients. Despite that, regionalization was associated with improved short-term outcomes, most notably: average minimally-invasive esophagectomy (MIE) operative time decreased by 2 hours (-135.9 minutes, 95% CI: -172.2, -99.7 minutes); length of stay (LOS) decreased by 2.3 days (95% CI: -3.4, -1.2 days); and 30-day complication rate decreased significantly, from 50.7% to 30.2% (OR 0.45, 95% CI: 0.25, 0.79). Regionalization was the only variable significantly and independently associated with all three outcomes in our adjusted multivariable models. Mortality, both at 30 and 90 days, decreased modestly but was low pre-regionalization, and the difference did not reach significance. Conclusions Regionalization of thoracic surgery in our hospital system resulted in esophagectomies being performed by more experienced surgeons at higher-volume centers, with a concomitant improvement in short-term outcomes. Patients undergoing esophagectomy, particularly MIE, post-regionalization benefited significantly from decreased LOS and perioperative complication rate. Our results suggest that, in a large integrated healthcare system, regionalization significantly improves overall outcomes for patients undergoing cancer esophagectomy.
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Affiliation(s)
- Sora Ely
- UCSF East Bay Surgery, Oakland, CA, USA.,Oakland Medical Center, Kaiser Permanente, Oakland, CA, USA
| | - Amy Alabaster
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Simon K Ashiku
- Oakland Medical Center, Kaiser Permanente, Oakland, CA, USA
| | - Ashish Patel
- Oakland Medical Center, Kaiser Permanente, Oakland, CA, USA
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Latchana N, Davis L, Coburn NG, Mahar A, Liu Y, Hammad A, Kagedan D, Elmi M, Siddiqui M, Earle CC, Hallet J. Population-based study of the impact of surgical and adjuvant therapy at the same or a different institution on survival of patients with pancreatic adenocarcinoma. BJS Open 2018; 3:85-94. [PMID: 30734019 PMCID: PMC6354229 DOI: 10.1002/bjs5.50115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/18/2018] [Indexed: 12/21/2022] Open
Abstract
Background Pancreatic cancer surgery is increasingly regionalized in high‐volume centres. Provision of adjuvant chemotherapy in the same institution can place a burden on patients, whereas receiving adjuvant chemotherapy at a different institution closer to home may create disparities in care. This study compared long‐term outcomes of patients with pancreatic adenocarcinoma receiving adjuvant chemotherapy at the institution where they had undergone surgery with outcomes for those receiving chemotherapy at a different institution. Methods This was a population‐based study of patients receiving adjuvant chemotherapy after resection of pancreatic adenocarcinoma performed at ten designated hepatopancreatobiliary centres in Ontario, Canada, between 2004 and 2014. Patients were divided into those receiving chemotherapy at the same institution as surgery or a different institution from where surgery was performed. The primary outcome was overall survival (OS). Multivariable Cox regression assessed the association between OS and each chemotherapy group, adjusted for potential confounders. Results Of 589 patients, 374 (63·5 per cent) received adjuvant chemotherapy at the same institution as surgery. After adjusting for age, sex, co‐morbidity, socioeconomic status, rural living, tumour stage, margin positivity and year of surgery, the location of adjuvant chemotherapy was not independently associated with OS (hazard ratio 1·03, 95 per cent c.i. 0·85 to 1·24). For patients who underwent chemotherapy at a different institution, mean travel distance to receive chemotherapy was less (22·9 km) than that needed for surgery (106·7 km). Conclusion After pancreatectomy for pancreatic adenocarcinoma at specialized hepatopancreatobiliary surgery centres, OS was not affected by the location of the centre delivering adjuvant chemotherapy. Receiving this treatment in a local centre reduced patients' travel burden.
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Affiliation(s)
- N Latchana
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - L Davis
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - N G Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - A Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Y Liu
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - A Hammad
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of General Surgery, Mansoura University, Mansoura, Egypt
| | - D Kagedan
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - M Elmi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - M Siddiqui
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - C C Earle
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - J Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Procedure-Specific Volume and Nurse-to-Patient Ratio: Implications for Failure to Rescue Patients Following Liver Surgery. World J Surg 2018; 43:910-919. [PMID: 30465087 DOI: 10.1007/s00268-018-4859-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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58
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Tao L, Schwab RB, San Miguel Y, Gomez SL, Canchola AJ, Gago-Dominguez M, Komenaka IK, Murphy JD, Molinolo AA, Martinez ME. Breast Cancer Mortality in Older and Younger Patients in California. Cancer Epidemiol Biomarkers Prev 2018; 28:303-310. [PMID: 30333222 DOI: 10.1158/1055-9965.epi-18-0353] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/08/2018] [Accepted: 10/10/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Breast cancer in younger patients is reported to be more aggressive and associated with lower survival; however, factors associated with age-specific mortality differences have not been adequately assessed. METHODS We used data from the population-based California Cancer Registry for 38,509 younger (18-49 years) and 121,573 older (50 years and older) women diagnosed with stage I to III breast cancer, 2005-2014. Multivariable Cox regression models were used to estimate breast cancer-specific mortality rate ratios (MRR) and 95% confidence intervals (CI), stratified by tumor subtype, guideline treatment, and care at an NCI-designated cancer center (NCICC). RESULTS Older breast cancer patients at diagnosis experienced 17% higher disease-specific mortality than younger patients, after multivariable adjustment (MRR = 1.17; 95% CI, 1.11-1.23). Higher MRRs (95% CI) were observed for older versus younger patients with hormone receptor (HR)+/HER2- (1.24; 1.14-1.35) and HR+/HER2+ (1.38; 1.17-1.62), but not for HR-/HER2+ (HR = 0.94; 0.79-1.12) nor triple-negative breast cancers (1.01; 0.92-1.11). The higher mortality in older versus younger patients was diminished among patients who received guideline-concordant treatment (MRR = 1.06; 95% CI, 0.99-1.14) and reversed among those seen at an NCICC (MRR = 0.86; 95% CI, 0.73-1.01). CONCLUSIONS Although younger women tend to be diagnosed with more aggressive breast cancers, adjusting for these aggressive features results in older patients having higher mortality than younger patients, with variations by age, tumor subtype, receipt of guideline treatment, and being cared for at an NCICC. IMPACT Higher breast cancer mortality in older compared with younger women could partly be addressed by ensuring optimal treatment and comprehensive patient-centered care.
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Affiliation(s)
- Li Tao
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, California
| | - Richard B Schwab
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Yazmin San Miguel
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Scarlett Lin Gomez
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Alison J Canchola
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Manuela Gago-Dominguez
- Moores Cancer Center, University of California, San Diego, La Jolla, California.,Fundación Galega Medicina Genómica, Instituto de Investigación Sanitaria de Santiago IDIS, Santiago de Compostela, Spain
| | | | - James D Murphy
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Alfredo A Molinolo
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Maria Elena Martinez
- Moores Cancer Center, University of California, San Diego, La Jolla, California. .,Family Medicine and Public Health, University of California, San Diego, La Jolla, California
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Chukmaitov AS, Kaidarova DR, Talaeyva ST, Sheppard VB, Xu H, Siangphoe U, Ettner SL. Analysis of Delays in Breast Cancer Treatment and Late-Stage Diagnosis in Kazakhstan. Asian Pac J Cancer Prev 2018; 19:2519-2525. [PMID: 30256046 PMCID: PMC6249466 DOI: 10.22034/apjcp.2018.19.9.2519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective: Although Kazakhstan has made significant investments to improve health and life expectancy of its population, high cancer rates persist, with breast cancer being the most prevalent type. Factors contributing to delays in treatment and late staging for breast cancer patients were assessed. Methods: A retrospective follow-up study with registry data identified 4,248 breast cancer patients in sixteen regions of Kazakhstan in 2014. We used logistic regressions to estimate (i) associations of treatment delays with patient demographics and cancer center regions; and (ii) associations of late-stage (III and IV) cancer diagnosis with patient demographics and cancer center regions, with and without controlling for treatment delays. Results: Breast cancer patients treated in regions located further away from Almaty City had higher risks of treatment delays. However, the risks of late-stage cancer diagnosis were greater for patients treated in Almaty City and those with treatment delays. Conclusion: The main driver of delayed treatment is cancer center region. Residents of Almaty City, a major urban area of Kazakhstan, may have a better access to a tertiary cancer center, resulting in less treatment delays. Referrals of sicker patients from neighboring regions to Almaty City for cancer treatment is likely to increase risks of late-stage diagnosis. New or upgraded cancer centers may reduce treatment delays, but their case-mix is likely to increase.
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Affiliation(s)
- Askar S Chukmaitov
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, VCU Massey Cancer Center, USA.
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Liu JB, Berian JR, Liu Y, Ko CY, Weber SM. Trends in perioperative outcomes of hospitals performing major cancer surgery. J Surg Oncol 2018; 118:694-703. [PMID: 30129674 DOI: 10.1002/jso.25171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/02/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Cancer surgery outcomes at National Cancer Institute-designated cancer centers (NCI-CCs) have been shown to vary, and have not been uniformly better than outcomes among non-NCI-CCs. We aimed to assess whether NCI-CCs have improved their short-term outcomes over time and whether variation across these centers has changed. METHODS Patients who underwent colectomy, esophagectomy, hepatectomy, pancreatectomy, and proctectomy for cancer were identified from the 2010 to 2016 American College of Surgeons' National Surgical Quality Improvement Program registry. Hospital trends in risk-adjusted, smoothed observed-to-expected ratios were assessed to evaluate improvement and variation in perioperative complications, stratified by NCI-CC status. RESULTS Complications occurred in 18.8% of 204 732 patients who underwent major cancer operations at 645 hospitals, and complications occurred in 19.9% of 60,903 patients at 54 NCI-CCs studied. More NCI-CCs than non-NCI-CCs improved over the period (85.2% vs 58.4%, P < 0.001; relative risk [RR] 1.46, 95% confidence interval [CI], 1.28-1.66); this remained significant after adjusting for years of participation (RR 1.33, 95% CI, 1.17-1.51). Variation in performance remained unchanged over time. CONCLUSION NCI-CCs were detected to have improved over a contemporary seven-year period and to have improved more than non-NCI-CCs. However, NCI-CCs do not uniformly outperform non-NCI-CCs, and variation in perioperative outcomes remains, warranting continued quality improvement efforts targeting cancer-specific operations.
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Affiliation(s)
- Jason B Liu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.,Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Julia R Berian
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Yaoming Liu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL
| | - Clifford Y Ko
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.,Department of Surgery, University of California Los Angeles David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Kantor O, Wang CH, Yao K. Regional Variation in Performance for Commission on Cancer Breast Quality Measures and Impact on Overall Survival. Ann Surg Oncol 2018; 25:3069-3075. [PMID: 29956092 DOI: 10.1245/s10434-018-6592-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Adherence to quality measures has become an important indicator of cancer center performance for high-quality cancer care. We examined regional variation in performance for Commission on Cancer breast quality measures and its impact on overall survival (OS) for those measures that have been shown to impact OS. METHODS Six breast quality measures were analyzed using the National Cancer Data Base from 2014 to 2015, and a multivariable model was used to assess performance for each measure by region. Kaplan-Meier and Cox proportional hazard models were used to examine OS between high- and low-performing centers from 2007 to 2012. RESULTS Overall, 305,391 women had surgery at 1322 institutions in nine US regions; 90.8% underwent needle biopsy (range 86.0-92.6% between regions, p < 0.01), 69.8% had breast-conserving surgery (BCS) for stage 0-II cancer (60.9-79.3%, p < 0.01), 85.2% aged < 70 years had radiation therapy (RT) after BCS (79.6-90.8%, p < 0.01), 78.3% of women with four or more positive nodes had post-mastectomy RT (70.9-84.5%, p < 0.01), 90.9% with hormone receptor (HR)-positive stage IB-III cancer had hormone therapy (83.7-95.1%, p < 0.01), and 89.4% aged < 70 years with HR-negative stage IB-III cancer had chemotherapy (87.6-91.4%, p < 0.01). Multivariate analyses adjusted for patient and facility factors found that region was the only consistent predictor of non-compliance across measures. With median 65-month follow-up, there was no difference in OS between high- and low-performing centers for the three measures that have been shown to impact OS. CONCLUSIONS There is significant regional variation in performance on the breast quality measures but this variation did not impact OS. Targeted efforts in certain areas of the country may help improve performance on these measures.
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Affiliation(s)
- Olga Kantor
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Chi-Hsiung Wang
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Biostatistical Core, NorthShore University HealthSystem Research Institute, Evanston, IL, USA
| | - Katharine Yao
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. .,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
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Trautmann F, Reißfelder C, Pecqueux M, Weitz J, Schmitt J. Evidence-based quality standards improve prognosis in colon cancer care. Eur J Surg Oncol 2018; 44:1324-1330. [PMID: 29885983 DOI: 10.1016/j.ejso.2018.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/09/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colon cancer requires interdisciplinary care with quality of initial surgical treatment being a major prognostic factor. Implementation of quality standards based on structural and procedural indicators in routine care via certification (Germany) or accreditation (USA) is an established quality assurance method. However, evidence on effects is scarce. We undertook a population-based cohort study to investigate the effectiveness of colon cancer care in certified vs non-certified hospitals. MATERIALS AND METHODS We utilized data of a large statutory health insurance including in- and outpatient data from 2005 to 2015 of >2 million individuals from Saxony, Germany. Case definitions were based on diagnosis, medical procedures and prescriptions. Patients treated in certified hospitals (CH) were compared to patients treated in non-certified hospitals (NCH) using logistic and Cox regression models adjusting for relevant confounders concerning overall survival (OS), disease-specific survival (DSS), 30-day mortality, recurrence, complications and second resections within 6 months after first resection (SR). RESULTS Overall, 6186 patients with incident colon cancer undergoing surgery were identified (mean age 74.1 ± 11.0 years, 51.1% male) with 2120 (34.3%) patients treated in a CH. Confounder-adjusted regression models indicated positive effects in CH on OS (HR = 0.90, 95%CI: 0.83-0.97), DSS (HR = 0.71, 95%CI: 0.57-0.88), 30-day mortality (OR = 0.69, 95%CI: 0.55-0.87) and SR (OR = 0.51, 95%CI: 0.30-0.87). These results remained stable after adjustment for hospital volume. 30-day mortality in 2014 was 41% lower in CH (7.4%) compared to NCH (12.6%). CONCLUSIONS This study indicates that the implementation and assurance of evidence-based quality standards has substantial positive effects on various patient-relevant outcomes in colon cancer care.
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Affiliation(s)
- Freya Trautmann
- National Center for Tumor Diseases (NCT), (partner Site) Dresden, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden and German Cancer Research Center (DKFZ), Fetscherstraße 74, 01307, Dresden, Germany; Center for Evidence-based Healthcare (ZEGV), University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christoph Reißfelder
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Mathieu Pecqueux
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jochen Schmitt
- National Center for Tumor Diseases (NCT), (partner Site) Dresden, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden and German Cancer Research Center (DKFZ), Fetscherstraße 74, 01307, Dresden, Germany; Center for Evidence-based Healthcare (ZEGV), University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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Duska LR. Access to quality gynecologic oncology care: A work in progress. Cancer 2018; 124:2680-2683. [DOI: 10.1002/cncr.31391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Linda R. Duska
- Division of Gynecologic Oncology; University of Virginia School of Medicine; Charlottesville Virginia
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Ho G, Wun T, Muffly L, Li Q, Brunson A, Rosenberg AS, Jonas BA, Keegan TH. Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California. Cancer 2018; 124:1938-1945. [PMID: 29451695 PMCID: PMC6911353 DOI: 10.1002/cncr.31296] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/11/2018] [Accepted: 01/19/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND To the authors' knowledge, few population-based studies to date have evaluated the association between location of care, complications with induction therapy, and early mortality in patients with acute myeloid leukemia (AML). METHODS Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999-2014), the authors identified adult (aged ≥18 years) patients with AML who received inpatient treatment within 30 days of diagnosis. A propensity score was created for treatment at a National Cancer Institute-designated cancer center (NCI-CC). Inverse probability-weighted, multivariable logistic regression models were used to determine associations between location of care, complications, and early mortality (death ≤60 days from diagnosis). RESULTS Of the 7007 patients with AML, 1762 (25%) were treated at an NCI-CC. Patients with AML who were treated at NCI-CCs were more likely to be aged ≤65 years, live in higher socioeconomic status neighborhoods, have fewer comorbidities, and have public health insurance. Patients treated at NCI-CCs had higher rates of renal failure (23% vs 20%; P = .010) and lower rates of respiratory failure (11% vs 14%; P = .003) and cardiac arrest (1% vs 2%; P = .014). After adjustment for baseline characteristics, treatment at an NCI-CC was associated with lower early mortality (odds ratio, 0.46; 95% confidence interval, 0.38-0.57). The impact of complications on early mortality did not differ by location of care except for higher early mortality noted among patients with respiratory failure treated at non-NCI-CCs. CONCLUSIONS The initial treatment of adult patients with AML at NCI-CCs is associated with a 53% reduction in the odds of early mortality compared with treatment at non-NCI-CCs. Lower early mortality may result from differences in hospital or provider experience and supportive care. Cancer 2018;124:1938-45. © 2018 American Cancer Society.
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Affiliation(s)
- Gwendolyn Ho
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
- Kaiser Permanente North Valley, Department of Hematology Oncology, Sacramento, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Aaron S. Rosenberg
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Brian A. Jonas
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
| | - Theresa H.M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California
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Madhavan S, Shelat VG, Soong SL, Woon WWL, Huey T, Chan YH, Junnarkar SP. Predicting morbidity of liver resection. Langenbecks Arch Surg 2018; 403:359-369. [PMID: 29417211 DOI: 10.1007/s00423-018-1656-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/25/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Multiple models have attempted to predict morbidity of liver resection (LR). This study aims to determine the efficacy of American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator and the Physiological and Operative Severity Score in the enUmeration of Mortality and Morbidity (POSSUM) in predicting post-operative morbidity in patients who underwent LR. METHODS A retrospective analysis was conducted on patients who underwent elective LR. Morbidity risk was calculated with the ACS-NSQIP surgical risk calculator and POSSUM equation. Two models were then constructed for both ACS-NSQIP and POSSUM-(1) the original risk probabilities from each scoring system and (2) a model derived from logistic regression of variables. Discrimination, calibration, and overall performance for ACS-NSQIP and POSSUM were compared. Sub-group analysis was performed for both primary and secondary liver malignancies. RESULTS Two hundred forty-five patients underwent LR. Two hundred twenty-three (91%) had malignant liver pathologies. The post-operative morbidity, 90-day mortality, and 30-day mortality rate were 38.3%, 3.7%, and 2.4% respectively. ACS-NSQIP showed superior discriminative ability, calibration, and performance to POSSUM (p = 0.03). Hosmer-Lemeshow plot demonstrated better fit of the ACS-NSQIP model than POSSUM in predicting morbidity. CONCLUSION In patients undergoing LR, the ACS-NSQIP surgical risk calculator was superior to POSSUM in predicting morbidity risk.
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Affiliation(s)
- Sudharsan Madhavan
- Ministry of Health Holdings, 1 Maritime Square, #11-25 HarbourFront Centre, Singapore, 099253, Republic of Singapore
| | - Vishal G Shelat
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Su-Lin Soong
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Winston W L Woon
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Terence Huey
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - Yiong H Chan
- Biostatistics Unit, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore
| | - Sameer P Junnarkar
- Hepato-Pancreatico-Biliary Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore.
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Mack M, Hamandi M. Is it time for national systems of care for valvular heart disease? EUROINTERVENTION 2018; 13:e2109-e2111. [PMID: 29624175 DOI: 10.4244/eijv13i18a347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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67
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Positive Impact of an Aortic Center Designation. Ann Vasc Surg 2018; 46:142-146. [DOI: 10.1016/j.avsg.2017.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022]
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Shah C, Badiyan SN, Keith K. Addressing the Challenges of Narrow Network Plans in Oncology. Int J Radiat Oncol Biol Phys 2017; 99:520-523. [PMID: 29280444 DOI: 10.1016/j.ijrobp.2017.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 07/07/2017] [Accepted: 07/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio.
| | - Shahed N Badiyan
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Katie Keith
- Georgetown University Law Center, Washington, DC
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García-Perdomo HA. Centros de excelencia del cáncer en Colombia: una manera fundamental de trabajar juntos. Rev Urol 2017. [DOI: 10.1016/j.uroco.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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71
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Luft HS. Comment on: "Measuring the Volume-Outcome Relation for Complex Hospital Surgery". APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:535-536. [PMID: 28577206 DOI: 10.1007/s40258-017-0334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Harold S Luft
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA.
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Trainee-associated outcomes in laparoscopic colectomy for cancer: propensity score analysis accounting for operative time, procedure complexity and patient comorbidity. Surg Endosc 2017; 32:702-711. [PMID: 28726138 DOI: 10.1007/s00464-017-5726-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 07/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical trainee association with operative outcomes is controversial. Studies are conflicting, possibly due to insufficient control of confounding variables such as operative time, case complexity, and heterogeneous patient populations. As operative complications worsen long-term outcomes in oncologic patients, understanding effect of trainee involvement during laparoscopic colectomy for cancer is of utmost importance. Here, we hypothesized that resident involvement was associated with worsened 30-day mortality and 30-day overall morbidity in this patient population. METHODS Patients undergoing laparoscopic colectomy for oncologic diagnosis from 2005 to 2012 were assessed using the American College of Surgeons National Surgical Quality Improvement Program dataset. Propensity score matching accounted for demographics, comorbidities, case complexity, and operative time. Attending only cases were compared to junior, middle, chief resident, and fellow level cohorts to assess primary outcomes of 30-day mortality and 30-day overall morbidity. RESULTS A total of 13,211 patients met inclusion criteria, with 4075 (30.8%) cases lacking trainee involvement and 9136 (69.2%) involving a trainee. Following propensity matching, junior (PGY 1-2) and middle level (PGY 3-4) resident involvement was not associated with worsened outcomes. Chief (PGY 5) resident involvement was associated with worsened 30-day overall morbidity (15.5 vs. 18.6%, p = 0.01). Fellow (PGY > 5) involvement was associated with worsened 30-day overall morbidity (16.0 vs. 21.0%, p < 0.001), serious morbidity (9.3 vs. 13.5%, p < 0.001), minor morbidity (9.8 vs. 13.1%, p = 0.002), and surgical site infection (7.9 vs. 10.5%, p = 0.006). No differences were seen in 30-day mortality for any resident level. CONCLUSION Following propensity-matched analysis of cancer patients undergoing laparoscopic colectomy, chief residents, and fellows were associated with worsened operative outcomes compared to attending along cases, while junior and mid-level resident outcomes were no different. Further study is necessary to determine what effect the PGY surgical trainee level has on post-operative morbidity in cancer patients undergoing laparoscopic colectomy in the context of multiple collinear factors.
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73
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Ajmani GS, James TA, Kantor O, Wang CH, Yao KA. The Impact of Facility Volume on Rates of Pathologic Complete Response to Neoadjuvant Chemotherapy Used in Breast Cancer. Ann Surg Oncol 2017; 24:3157-3166. [DOI: 10.1245/s10434-017-5969-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Indexed: 11/18/2022]
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74
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Qadan M, Davies AR, Polk HC, Allum WH, Brennan MF. Cancer care in the developed world: A comparison of surgical oncology training programs. Am J Surg 2017; 215:1-7. [PMID: 28619263 DOI: 10.1016/j.amjsurg.2017.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/01/2017] [Accepted: 05/12/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
| | - Andrew R Davies
- Department of Surgery, Guy's and St. Thomas NHS Foundation Trust, London, England, UK
| | - Hiram C Polk
- Department of Surgery, University of Louisville, Louisville, KY, USA; Kentucky Department of Public Health, Louisville, KY, USA
| | - William H Allum
- Department of Surgery, Royal Marsden Hospital, London, England, UK
| | - Murray F Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Onega T, Alford-Teaster J, Wang F. Population-based geographic access to parent and satellite National Cancer Institute Cancer Center Facilities. Cancer 2017; 123:3305-3311. [PMID: 28464212 DOI: 10.1002/cncr.30727] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Satellite facilities of National Cancer Institute (NCI) cancer centers have expanded their regional footprints. This study characterized geographic access to parent and satellite NCI cancer center facilities nationally overall and by sociodemographics. METHODS Parent and satellite NCI cancer center facilities, which were geocoded in ArcGIS, were ascertained. Travel times from every census tract in the continental United States and Hawaii to the nearest parent and satellite facilities were calculated. Census-based population attributes were used to characterize measures of geographic access for sociodemographic groups. RESULTS From the 62 NCI cancer centers providing clinical care in 2014, 76 unique parent locations and 211 satellite locations were mapped. The overall proportion of the population within 60 minutes of a facility was 22% for parent facilities and 32.7% for satellite facilities. When satellites were included for potential access, the proportion of some racial groups for which a satellite was the closest NCI cancer center facility increased notably (Native Americans, 22.6% with parent facilities and 39.7% with satellite facilities; whites, 34.8% with parent facilities and 50.3% with satellite facilities; and Asians, 40.0% with parent facilities and 54.0% with satellite facilities), with less marked increases for Hispanic and black populations. Rural populations of all categories had dramatically low proportions living within 60 minutes of an NCI cancer center facility of any type (1.0%-6.6%). Approximately 14% of the population (n = 43,033,310) lived more than 180 minutes from a parent or satellite facility, and most of these individuals were Native Americans and/or rural residents (37% of Native Americans and 41.7% of isolated rural residents). CONCLUSIONS Racial/ethnic and rural populations showed markedly improved geographic access to NCI cancer center care when satellite facilities were included. Cancer 2017;123:3305-11. © 2017 American Cancer Society.
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Affiliation(s)
- Tracy Onega
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jennifer Alford-Teaster
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Fahui Wang
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, Louisiana
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Ho G, Jonas BA, Li Q, Brunson A, Wun T, Keegan THM. Early mortality and complications in hospitalized adult Californians with acute myeloid leukaemia. Br J Haematol 2017; 177:791-799. [PMID: 28419422 DOI: 10.1111/bjh.14631] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/20/2016] [Accepted: 12/31/2016] [Indexed: 11/28/2022]
Abstract
Few studies have evaluated the impact of complications, sociodemographic and clinical factors on early mortality (death ≤60 days from diagnosis) in acute myeloid leukaemia (AML) patients. Using data from the California Cancer Registry linked to hospital discharge records from 1999 to 2012, we identified patients aged ≥15 years with AML who received inpatient treatment (N = 6359). Multivariate logistic regression analyses were used to assess the association of complications with early mortality, adjusting for sociodemographic factors, comorbidities and hospital type. Early mortality decreased over time (25·3%, 1999-2000; 16·8%, 2011-2012) across all age groups, but was higher in older patients (6·9%, 15-39, 11·4%, 40-54, 18·6% 55-65, and 35·8%, >65 years). Major bleeding [Odds ratio (OR) 1·5, 95% confidence interval (CI) 1·3-1·9], liver failure (OR 1·9, 95% CI 1·1-3·1), renal failure (OR 2·4, 95% CI 2·0-2·9), respiratory failure (OR 7·6, 95% CI 6·2-9·3) and cardiac arrest (OR 15·8, 95% CI 8·7-28·6) were associated with early mortality. Higher early mortality was also associated with single marital status, low neighbourhood socioeconomic status, lack of health insurance and comorbidities. Treatment at National Cancer Institute-designated cancer centres was associated with lower early mortality (OR 0·5, 95% CI 0·4-0·6). In conclusion, organ dysfunction, hospital type and sociodemographic factors impact early mortality. Further studies should investigate how differences in healthcare delivery affect early mortality.
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Affiliation(s)
- Gwendolyn Ho
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Brian A Jonas
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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Alvarez E, Keegan T, Johnston EE, Haile R, Sanders L, Saynina O, Chamberlain LJ. Adolescent and young adult oncology patients: Disparities in access to specialized cancer centers. Cancer 2017; 123:2516-2523. [PMID: 28241089 DOI: 10.1002/cncr.30562] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Adolescents and young adults (AYAs) ages 15 to 39 years with cancer continue to experience disparate survival outcomes compared with their younger and older counterparts. This may be caused in part by differential access to specialized cancer centers (SCCs), because treatment at SCCs has been associated with improved overall survival. The authors examined social and clinical factors associated with AYA use of SCCs (defined as Children's Oncology Group-designated or National Cancer Institute-designated centers). METHODS A retrospective, population-based analysis was performed on all hospital admissions of AYA oncology patients in California during 1991 through 2014 (n = 127,250) using the Office of Statewide Health Planning and Development database. Multivariable logistic regression analyses examined the contribution of social and clinical factors on always receiving care from an SCC (vs sometimes or never). Results are presented as adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Over the past 20 years, the percentage of patients always receiving inpatient care at an SCC increased over time (from 27% in 1991 to 43% in 2014). In multivariable regression analyses, AYA patients were less likely to always receive care from an SCC if they had public insurance (OR, 0.64; 95% CI, 0.62-0.66), were uninsured (OR, 0.51; 95% CI, 0.46-0.56), were Hispanic (OR, 0.88; 95% CI, 0.85-0.91), lived > 5 miles from an SCC, or had a diagnosis other than leukemia and central nervous system tumors. CONCLUSIONS Receiving care at an SCC was influenced by insurance, race/ethnicity, geography, and tumor type. Identifying the barriers associated with decreased SCC use is an important first step toward improving outcomes in AYA oncology patients. Cancer 2017;123:2516-23. © 2017 American Cancer Society.
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Affiliation(s)
- Elysia Alvarez
- Division of Pediatric Hematology and Oncology, Stanford University School of Medicine, Stanford, California
| | - Theresa Keegan
- Division of Hematology and Oncology, University of California, Davis School of Medicine, Sacramento, California
| | - Emily E Johnston
- Division of Pediatric Hematology and Oncology, Stanford University School of Medicine, Stanford, California
| | - Robert Haile
- Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Lee Sanders
- Division of General Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Olga Saynina
- The Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, Stanford, California
| | - Lisa J Chamberlain
- Division of General Pediatrics, Stanford University School of Medicine, Stanford, California
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Sinha AK, Patel JR, Shen Y, Ueno NT, Giordano SH, Tripathy D, Lopez DS, Barcenas CH. Location of Receipt of Initial Treatment and Outcomes in Long-Term Breast Cancer Survivors. PLoS One 2017; 12:e0170081. [PMID: 28085940 PMCID: PMC5234813 DOI: 10.1371/journal.pone.0170081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/28/2016] [Indexed: 01/07/2023] Open
Abstract
Purpose Cancer outcomes differ depending on where treatment is received. We assessed differences in outcomes in long-term breast cancer survivors at a specialty care hospital by location of their initial treatment. Methods We retrospectively examined a cohort of women diagnosed with invasive early-stage breast cancer who did not experience recurrence for at least 5 years after the date of diagnosis and were evaluated at The University of Texas MD Anderson Cancer Center between January 1997 and August 2008. The location of initial treatment was categorized as MD Anderson (MDA-treated) or other (OTH-treated). Outcomes analyzed included recurrence-free survival (RFS), distant relapse-free survival (DRFS), and overall survival (OS). The Kaplan-Meier product-limit method was used to compare outcomes between the two groups. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results We identified 5,091 breast cancer survivors (median follow-up 8.6 years), of whom 89.1% were MDA-treated. The 10-year OS, RFS, and DRFS rates were 90.9%, 88.4%, and 89.0% in the MDA-treated group and 74.3%, 49.8%, and 52.7% in the OTH-treated group, respectively. We observed worse outcomes in the OTH-group in both the univariate analysis and the multivariable analysis (OS: HR = 4.8, 95% CI = 3.9–6.0; RFS: HR = 5.8, 95% CI = 4.8–7.0; DRFS: HR = 5.4, 95% CI = 4.5–6.6). Conclusion Long-term breast cancer survivors who initiated their treatment at MD Anderson had better outcomes. Location of initial treatment could be an independent risk factor for survival outcomes at specialty care hospitals. This analysis has limitations inherent to retrospective observational studies such as other unmeasured variables may be associated with worse prognosis.
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MESH Headings
- Adult
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Combined Modality Therapy
- Female
- Health Services/statistics & numerical data
- Humans
- Middle Aged
- Neoplasm Grading
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasm Staging
- Prognosis
- Quality of Health Care/organization & administration
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Arup K. Sinha
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Department of Biostatistics, The University of Texas School of Public Health, Houston, Texas, United States of America
| | - Jenil R. Patel
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, United States of America
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Naoto T. Ueno
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Sharon H. Giordano
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - David S. Lopez
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, United States of America
| | - Carlos H. Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
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79
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Frontier of Development for Metallodrugs on the Basis of Metallomic Pharmacology and Medicinal Inorganic Chemistry. Metallomics 2017. [DOI: 10.1007/978-4-431-56463-8_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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80
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Sippey M, Spaniolas K, Kasten KR. Elucidating Trainee Effect on Outcomes for General, Gynecologic, and Urologic Oncology Procedures. J INVEST SURG 2016; 30:359-367. [PMID: 27929699 DOI: 10.1080/08941939.2016.1255805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Surgical complications delay adjuvant therapy in oncology patients. Current literature remains unclear regarding resident effect on postoperative outcomes, with inappropriate coverage possibly endangering patients in spite of attending oversight. We assessed resident postgraduate year (PGY) effect on 30-day overall morbidity in cancer patients undergoing major intra-abdominal and non-abdominal surgery. METHODS Patients undergoing non-emergent major intra- and extra-abdominal operations from 2005-2012 were queried using the American College of Surgeons' National Surgical Quality Improvement Program. Attending alone and resident PGY cohorts were compared for demographics, 30-day overall morbidity, mortality, and relevant outcomes. RESULTS A total of 156,941 cancer patients undergoing major intra-abdominal (n = 76,385) or major non-abdominal (n = 80,556) procedures were captured. Demographics were clinically similar across attending and PGY levels. Rates of overall morbidity increased significantly with PGY level, along with operative time and length of stay. For major intra-abdominal procedures, all resident levels except PGY2 level adversely affected overall morbidity. Above PGY4 level, resident involvement had a stronger association with adverse outcome than preoperative comorbidities and preoperative chemotherapy. Interestingly, gastric, gall bladder, liver, pancreas, esophageal, and thyroid procedures demonstrated no effect of resident involvement on overall morbidity. CONCLUSIONS Resident PGY is independently associated with increased overall morbidity in patients undergoing selected major surgical procedures. Understanding surgical procedures affected by resident involvement will maximize outcomes.
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Affiliation(s)
- Megan Sippey
- a Department of Surgery , Brody School of Medicine at East Carolina University , Greenville , North Carolina , USA
| | - Konstantinos Spaniolas
- a Department of Surgery , Brody School of Medicine at East Carolina University , Greenville , North Carolina , USA
| | - Kevin R Kasten
- b Department of Surgery , Carolinas Health Care System , Charlotte , North Carolina , USA
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81
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Le Guyader-Peyrou S, Orazio S, Dejardin O, Maynadié M, Troussard X, Monnereau A. Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role? Haematologica 2016; 102:584-592. [PMID: 27909221 PMCID: PMC5394966 DOI: 10.3324/haematol.2016.152918] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/24/2016] [Indexed: 12/24/2022] Open
Abstract
The survival of patients with diffuse large B-cell lymphoma has increased during the last decade as a result of addition of anti-CD20 to anthracycline-based chemotherapy. Although the trend is encouraging, there are persistent differences in survival within and between the USA and European countries suggesting that non-biological factors play a role. Our aim was to investigate the influence of such factors on relative survival of patients with diffuse large B-cell lymphoma. We conducted a retrospective, multicenter, registry-based study in France on 1165 incident cases of diffuse large B-cell lymphoma between 2002 and 2008. Relative survival analyses were performed and missing data were controlled with the multiple imputation method. In a multivariate analysis, adjusted for age, sex and International Prognostic Index, we confirmed that time period was associated with a better 5-year relative survival. The registry area, the medical specialty of the care department (onco-hematology versus other), the time to travel to the nearest teaching hospital, the place of treatment (teaching versus not-teaching hospital -borderline significance), a comorbidity burden and marital status were independently associated with the 5-year relative survival. Adjusted for first-course treatment, inclusion in a clinical trial and treatment discussion in a multidisciplinary meeting were strongly associated with a better survival outcome. In contrast, socio-economic status (determined using the European Deprivation Index) was not associated with outcome. Despite therapeutic advances, various non-biological factors affected the relative survival of patients with diffuse large B-cell lymphoma. The notion of lymphoma-specific expertise seems to be essential to achieve optimal care management and reopens the debate regarding centralization of these patients’ care in hematology/oncology departments.
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Affiliation(s)
- Sandra Le Guyader-Peyrou
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonie, Bordeaux, France .,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, F-33000, France
| | - Sébastien Orazio
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonie, Bordeaux, France.,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, F-33000, France
| | - Olivier Dejardin
- University Hospital of Caen, U1086 INSERM UCBN «Cancers & Préventions», France
| | - Marc Maynadié
- Registre des Hémopathies Malignes de Côte d'Or, EA4184, Université de Bourgogne, Dijon, France
| | - Xavier Troussard
- Registre des Hémopathies Malignes de Basse Normandie, Caen, France.,Laboratoire d'Hématologie, CHU de Caen, France
| | - Alain Monnereau
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonie, Bordeaux, France.,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, F-33000, France
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82
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Era of a Single Population-Based Payment to a Cancer Center: Delivering the Value of Interventional Oncology in Accountable Care Organizations. Cancer J 2016; 22:423-426. [PMID: 27870686 DOI: 10.1097/ppo.0000000000000231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To curtail increasing health care costs, the government has ushered in the era of the Accountable care organization (ACO). The purposes of this review are to evaluate the effects the ACO will have on the practice of interventional oncology and its role in cancer care and to explore methods to assimilate. Proposed action points include integration into the modern-day cancer center, adoption of an outpatient clinic, mandatory performance measures, and workflow and cost analysis. If adaptations are made, interventional oncology can continue its role in cancer treatment, will provide more effective care, and reach more patients in the new ACO.
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83
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Altieri MS, Yang J, Yin D, Frenkel C, Talamini M, Telem DA, Pryor A. Presence of a fellowship improves perioperative outcomes following hepatopancreatobiliary procedures. Surg Endosc 2016; 31:2918-2924. [DOI: 10.1007/s00464-016-5306-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
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84
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de Castro TP, Waissmann W, Simões TC, de Mello RCR, Carvalho DP. Predictors for papillary thyroid cancer persistence and recurrence: a retrospective analysis with a 10-year follow-up cohort study. Clin Endocrinol (Oxf) 2016; 85:466-74. [PMID: 26834009 DOI: 10.1111/cen.13032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We aimed to determine outcome predictors of papillary thyroid cancer (PTC) persistence and recurrence, separately. CONTEXT The factors contributing to either persistence or recurrence of PTC are poorly defined, as both outcomes are usually evaluated together. DESIGN AND PATIENTS In this 10-year follow-up cohort study, 190 PTC patients were evaluated (18-85 years old; registered from 1 January 1990 to31 December 1999 at a Brazilian Cancer Care referral Hospital). After initial surgery, we examined persistence (disease detected up to 1 year), recurrence (disease detected after 1 year) and PTC-free status (disease absence during follow-up). MEASUREMENTS Outcome predictors were modelled using multinomial logit regression analysis. RESULTS The univariate analysis showed that persistence and recurrence were significantly associated with lymph node metastasis (OR = 12·33; OR = 2·84, respectively), local aggressiveness (OR = 5·22; OR = 3·35) and extrathyroidal extension (OR = 5·07; OR = 7·11). Persistence was associated with male sex (OR = 3·49), age above 45 years old at diagnosis (OR = 1·03), macroscopic lymph node metastasis (OR = 5·85), local aggressiveness (OR = 5·22), each 1-cm tumour size increase (OR = 1·34), a cancer care referral hospital as the place of initial surgery (OR = 2·3), thyroidectomy or near total thyroidectomy(OR = 3·03) and neck dissection (OR = 3·19). Recurrence was associated with the time of radioactive iodine ((131) I) therapy (OR = 3·71). After data modelling, persistence was associated with macroscopic lymph node metastasis (OR = 6·17), 1-cm increases in tumour size (OR = 1·30) and thyroidectomy or near total thyroidectomy (OR = 3·82), while recurrence was associated with surgery at referral hospital (OR = 3·79). CONCLUSIONS The best predictors of persistence were tumour size and macroscopic lymph node metastasis; when the initial surgery is of quality, the recurrence depends more on tumour's biology aspects.
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Affiliation(s)
- Taciana Padilha de Castro
- Department of Endocrinology, Medical School, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
- Research Center for Health Work and Human Ecology - CESTEH-ENSP/FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - William Waissmann
- Research Center for Health Work and Human Ecology - CESTEH-ENSP/FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Taynãna César Simões
- Department of Epidemiology and Quantitative Methods in Health - DEMQS-ENSP/FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Rossana Corbo R de Mello
- Department of Endocrinology, Medical School, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
- Cancer Hospital 1, National Institute of Cancer INCA, Rio de Janeiro, RJ, Brazil
| | - Denise P Carvalho
- Department of Endocrinology, Medical School, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
- Carlos Chagas Filho Institute of Biophysics - IBCCF/UFRJ, Rio de Janeiro, RJ, Brazil
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85
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Hospital Volume and Survival After Hepatocellular Carcinoma Diagnosis. Am J Gastroenterol 2016; 111:967-75. [PMID: 27166130 DOI: 10.1038/ajg.2016.181] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 04/01/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The association between hospital volume and outcome following high-risk low volume cancer surgery is well documented. However, this association is not well understood in cancer patients undergoing non-surgical therapies. We explored this association in a cohort of newly diagnosed patients with hepatocellular carcinoma (HCC). METHODS Data from the 2000 through 2011 in Texas Cancer Registry were used to study adults with newly diagnosed HCC (17,231 patients from 322 hospitals). Hospital volume was stratified into low and high volume using Contal's outcome-based method. A multivariable Cox regression with shared frailty was used to evaluate the association between hospital volume and overall survival. The relationship between treatment modality and hospital volume was explored using mixed effects logistic regression. RESULTS The majority (61%) of HCC patients were seen in 21 high-volume hospitals. An annual hospital volume cutoff point of 24 patients was determined to stratify between high- and low-volume hospitals. Patients at high-volume hospitals presented more commonly with localized disease (56 vs. 50%, P<0.01) and were more likely to receive curative therapies including surgical resection, liver transplantation, or ablation (22 vs. 12%, P<0.01). High-volume hospitals were significantly associated with improved survival (HR=0.96, 95% CI=0.94-0.98). In multivariable analysis, hospital volume was associated with increased overall treatment utilization (OR=1.3, 95% CI=1.2-1.4). CONCLUSIONS Hospital volume is associated with improved overall survival, particularly in localized HCC. Improved survival may be mediated by increased utilization of treatments in high HCC volume hospitals.
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86
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Freeman AT, Meyer AM, Smitherman AB, Zhou L, Basch EM, Shea TC, Wood WA. Statewide geographic variation in outcomes for adults with acute myeloid leukemia in North Carolina. Cancer 2016; 122:3041-50. [DOI: 10.1002/cncr.30139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/30/2016] [Accepted: 05/16/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Ashley T. Freeman
- Division of Hematology/Oncology; University of North Carolina; Chapel Hill North Carolina
| | - Anne-Marie Meyer
- Integrated Cancer Information and Surveillance System; University of North Carolina; Chapel Hill North Carolina
| | - Andrew B. Smitherman
- Division of Pediatric Hematology/Oncology; University of North Carolina; Chapel Hill North Carolina
| | - Lei Zhou
- Integrated Cancer Information and Surveillance System; University of North Carolina; Chapel Hill North Carolina
| | - Ethan M. Basch
- Division of Hematology/Oncology; University of North Carolina; Chapel Hill North Carolina
| | - Thomas C. Shea
- Division of Hematology/Oncology; University of North Carolina; Chapel Hill North Carolina
| | - William A. Wood
- Division of Hematology/Oncology; University of North Carolina; Chapel Hill North Carolina
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87
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Eaton BR, Pugh SL, Bradley JD, Masters G, Kavadi VS, Narayan S, Nedzi L, Robinson C, Wynn RB, Koprowski C, Johnson DW, Meng J, Curran WJ. Institutional Enrollment and Survival Among NSCLC Patients Receiving Chemoradiation: NRG Oncology Radiation Therapy Oncology Group (RTOG) 0617. J Natl Cancer Inst 2016; 108:djw034. [PMID: 27206636 DOI: 10.1093/jnci/djw034] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 02/09/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this analysis is to evaluate the effect of institutional accrual volume on clinical outcomes among patients receiving chemoradiation for locally advanced non-small cell lung cancer (LA-NSCLC) on a phase III trial. METHODS Patients with LA-NSCLC were randomly assigned to 60 Gy or 74 Gy radiotherapy (RT) with concurrent carboplatin/paclitaxel +/- cetuximab on NRG Oncology RTOG 0617. Participating institutions were categorized as low-volume centers (LVCs) or high-volume centers (HVCs) according to the number of patients accrued (≤3 vs > 3). All statistical tests were two-sided. RESULTS Range of accrual for LVCs (n = 195) vs HVCs (n = 300) was 1 to 3 vs 4 to 18 patients. Baseline characteristics were similar between the two cohorts. Treatment at a HVC was associated with statistically significantly longer overall survival (OS) and progression-free survival (PFS) compared with treatment at a LVC (median OS = 26.2 vs 19.8 months; HR = 0.70, 95% CI = 0.56 to 0.88, P = .002; median PFS: 11.4 vs 9.7 months, HR = 0.80, 95% CI = 0.65-0.99, P = .04). Patients treated at HVCs were more often treated with intensity-modulated RT (54.0% vs 39.5%, P = .002), had a lower esophageal dose (mean = 26.1 vs 28.0 Gy, P = .03), and had a lower heart dose (median = V5 Gy 38.2% vs 54.1%, P = .006; V50 Gy 3.6% vs 7.3%, P < .001). Grade 5 adverse events (AEs) (5.3% vs 9.2%, P = .09) and RT termination because of AEs (1.3% vs 4.1%, P = .07) were less common among patients treated at HVCs. HVC remained independently associated with longer OS (P = .03) when accounting for other factors. CONCLUSION Treatment at institutions with higher clinical trial accrual volume is associated with longer OS among patients with LA-NSCLC participating in a phase III trial.
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Affiliation(s)
- Bree R Eaton
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Stephanie L Pugh
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Jeffrey D Bradley
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Greg Masters
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Vivek S Kavadi
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Samir Narayan
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Lucien Nedzi
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Cliff Robinson
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Raymond B Wynn
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Christopher Koprowski
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Douglas W Johnson
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Joanne Meng
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
| | - Walter J Curran
- Winship Cancer Institute of Emory University, Atlanta, GA (BRE, WJCJr); NRG Oncology Statistics and Data Management Center, Philadelphia, PA (SLP); Washington University School of Medicine, St. Louis, MO (JDB, CR); Christiana Care/Helen Graham Medical Center, Newark, DE (GM); USON-Texas Oncology, Sugarland, TX (VSK); Michigan Cancer Research Consortium, Ann Arbor, MI (SN); University of Texas Southwestern Medical School, Dallas, TX (LN); University of Pittsburgh Medical Center, Pittsburgh, PA (RBW); Christiana Care Health System, Wilmington, DE (CK); Florida Radiation Oncology Group, Jacksonville, FL (DWJ); The Ottawa Hospital, Ottawa, ON, Canada (JM)
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Pfister DG, Rubin DM, Elkin EB, Neill US, Duck E, Radzyner M, Bach PB. Risk Adjusting Survival Outcomes in Hospitals That Treat Patients With Cancer Without Information on Cancer Stage. JAMA Oncol 2016; 1:1303-10. [PMID: 26448610 DOI: 10.1001/jamaoncol.2015.3151] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Instituting widespread measurement of outcomes for cancer hospitals using administrative data is difficult owing to lack of cancer-specific information such as disease stage. OBJECTIVE To evaluate the performance of hospitals that treat patients with cancer using Medicare data for outcome ascertainment and risk adjustment and to assess whether hospital rankings based on these measures are altered by the addition of cancer-specific information. DESIGN, SETTING, AND PARTICIPANTS Risk-adjusted cumulative mortality rates of patients with cancer were captured in Medicare claims data from 2005 through 2009 nationally and assessed at the hospital level. Similar analyses were conducted using Surveillance, Epidemiology, and End Results (SEER)-Medicare data for the subset of the United States covered by the SEER program to determine whether the inclusion of cancer-specific information (only available in cancer registries) in risk adjustment altered measured hospital performance. Data were from 729 279 fee-for-service Medicare beneficiaries treated for cancer in 2006 at hospitals treating 10 or more patients with each of the following cancers, according to Medicare claims: lung, prostate, breast, colon, and other. An additional sample of 18 677 similar patients were included from the SEER-Medicare administrative data. MAIN OUTCOMES AND MEASURES Risk-adjusted mortality overall and by cancer category, stratified by type of hospital; measures of correlation and agreement between hospital-level outcomes risk adjusted using Medicare data alone and Medicare data with SEER data. RESULTS There were large survival differences between different types of hospitals that treat Medicare patients with cancer. At 1 year, mortality for patients treated by hospitals exempt from the Medicare prospective payment system was 10% lower than at community hospitals (18% vs 28%) across all cancers, and the pattern persisted through 5 years of follow-up and within specific cancer categories. Performance ranking of hospitals was consistent with or without SEER-Medicare disease stage information (weighted κ ≥ 0.81). CONCLUSIONS AND RELEVANCE Potentially important outcome differences exist between different types of hospitals that treat patients with cancer after risk adjustment using information in Medicare administrative data. This type of risk adjustment may be adequate for evaluating hospital performance, since the additional adjustment for data available only in cancer registries does not seem to appreciably alter measures of performance.
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Affiliation(s)
| | - David M Rubin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena B Elkin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ushma S Neill
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elaine Duck
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark Radzyner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter B Bach
- Memorial Sloan Kettering Cancer Center, New York, New York
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Abstract
Accurate quality measurement that allows for and results in improvement is essential to colon and rectal surgery. Currently, no consensus exists as to which variables are most important in measuring outcomes. Debate continues concerning the "best" variables to measure from a structural, process, and outcomes standpoint. Although American College of Surgeons National Surgical Quality Improvement Program provides an opportunity for outcomes measurement in general and vascular surgery, there is no specific quality improvement tool available for colon and rectal surgery. However, there is growing literature testing the validity of candidate variables to be used in such a data collection system. This article evaluates the current objective assessment measurements used for quality improvement in colon and rectal surgery.
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Affiliation(s)
- Aneel Damle
- Department of General Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Karim Alavi
- Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts
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90
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James TA, Wong SL, Carp NZ. Measuring Quality in Cancer Care: A Critical Need for Clinician Engagement. Am J Med Qual 2016; 31:389-91. [PMID: 27030688 DOI: 10.1177/1062860616639639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ted A James
- University of Vermont College of Medicine, Burlington, VT Quality Integration Committee, Commission on Cancer, Chicago, IL
| | - Sandra L Wong
- Quality Integration Committee, Commission on Cancer, Chicago, IL Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, NH
| | - Ned Z Carp
- Quality Integration Committee, Commission on Cancer, Chicago, IL Main Line Health-Lankenau Medical Center, Wynnewood, PA
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91
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Pagès PB, Cottenet J, Mariet AS, Bernard A, Quantin C. In-hospital mortality following lung cancer resection: nationwide administrative database. Eur Respir J 2016; 47:1809-17. [PMID: 26965293 DOI: 10.1183/13993003.00052-2016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/08/2016] [Indexed: 02/06/2023]
Abstract
Our aim was to determine the effect of a national strategy for quality improvement in cancer management (the "Plan Cancer") according to time period and to assess the influence of type and volume of hospital activity on in-hospital mortality (IHM) within a large national cohort of patients operated on for lung cancer.From January 2005 to December 2013, 76 235 patients were included in the French Administrative Database. Patient characteristics, hospital volume of activity and hospital type were analysed over three periods: 2005-2007, 2008-2010 and 2011-2013.Global crude IHM was 3.9%: 4.3% during 2005-2007, 4% during 2008-2010 and 3.5% during 2011-2013 (p<0.01). 296, 259 and 209 centres performed pulmonary resections in 2005-2007, 2008-2010 and 2011-2013, respectively (p<0.01). The risk of death was higher in centres performing <13 resections per year than in centres performing >43 resections per year (adjusted (a)OR 1.48, 95% CI 1.197-1.834). The risk of death was lower in the period 2011-2013 than in the period 2008-2010 (aOR 0.841, 95% CI 0.764-0.926). Adjustment variables (age, sex, Charlson score and type of resection) were significantly linked to IHM, whereas the type of hospital was not.The French national strategy for quality improvement seems to have induced a significant decrease in IHM.
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Affiliation(s)
- Pierre-Benoit Pagès
- Dept of Thoracic Surgery, Centre Hospitalier Universitaire Dijon, Bocage Central, Dijon, France INSERM UMR 866, Centre Hospitalier Universitaire Bocage, University of Burgundy, Dijon, France
| | - Jonathan Cottenet
- Department of Biostatistics and Medical Informatics, Centre Hospitalier Universitaire Dijon, Bocage Central, Dijon, France
| | - Anne-Sophie Mariet
- Department of Biostatistics and Medical Informatics, Centre Hospitalier Universitaire Dijon, Bocage Central, Dijon, France
| | - Alain Bernard
- Dept of Thoracic Surgery, Centre Hospitalier Universitaire Dijon, Bocage Central, Dijon, France
| | - Catherine Quantin
- Department of Biostatistics and Medical Informatics, Centre Hospitalier Universitaire Dijon, Bocage Central, Dijon, France INSERM, CIC 1432, Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials Unit, Centre Hospitalier Universitaire Bocage, University of Burgundy, Dijon, France INSERM UMR 1181, Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, Centre Hospitalier Universitaire Bocage, University of Burgundy, Dijon, France
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92
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Althumairi AA, Canner JK, Gorin MA, Fang SH, Gearhart SL, Wick EC, Safar B, Bivalacqua TJ, Efron JE. Reduction of Costs for Pelvic Exenteration Performed by High Volume Surgeons: Analysis of the Maryland Health Service Cost Review Commission Database. Am Surg 2016. [DOI: 10.1177/000313481608200123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High volume hospitals (HVHs) and high volume surgeons (HVSs) have better outcomes after complex procedures, but the association between surgeon and hospital volumes and patient outcomes is not completely understood. Our aim was to evaluate the impact of surgeon and hospital volumes, and their interaction, on postoperative outcomes and costs in patients undergoing pelvic exenteration (PE) in the state of Maryland. A review of the Maryland Health Services Cost Review Commission database between 2000 and 2011 was performed. Patients were compared for demographics and clinical variables. The differences in length of hospital stay, length of intensive care unit (ICU) stay, operating room (OR) cost, and total cost were compared for surgeon volume and hospital volume controlling for all other factors. Surgery performed by HVS at HVH had the shortest ICU stay and lowest OR cost. When PE was performed by a low volume surgeon at an HVH, the OR cost and total cost were the highest and increased by $2,683 ( P < 0.0001) and $16,076 ( P < 0.0001), respectively. OR costs reduced when surgery was performed by an HVS at an HVH ($-1632, P = 0.008). PE performed by HVS at HVH is significantly associated with lower OR costs and ICU stay. We feel this is indicative of lower complication rates and higher quality care.
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Affiliation(s)
- Azah A. Althumairi
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Joseph K. Canner
- Center for Surgical Trials and Outcomes Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael A. Gorin
- Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Sandy H. Fang
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Susan L. Gearhart
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Elizabeth C. Wick
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Bashar Safar
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Trinity J. Bivalacqua
- Center for Surgical Trials and Outcomes Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jonathan E. Efron
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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93
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Ailawadhi S, Advani P, Yang D, Ghosh R, Swaika A, Roy V, Foran J, Colon-Otero G, Chanan-Khan A. Impact of access to NCI- and NCCN-designated cancer centers on outcomes for multiple myeloma patients: A SEER registry analysis. Cancer 2015; 122:618-25. [PMID: 26565660 DOI: 10.1002/cncr.29771] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/18/2015] [Accepted: 09/30/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND National Cancer Institute (NCI)/National Comprehensive Cancer Network (NCCN)-designated cancer centers (CCs) offer patients state-of-the-art treatment, but their impact on multiple myeloma (MM) patient outcomes has not been evaluated. METHODS Adult MM patients diagnosed between 1973 and 2011 were identified from the Surveillance, Epidemiology, and End Results database and were stratified by the county of residence at the time of diagnosis and the year of CC designation. The influence of NCI/NCCN CC access, race, and the year of diagnosis on overall survival (OS) was evaluated with a Cox regression model. RESULTS A statistically significant OS improvement was noted in patients diagnosed after 1995 with access to 2 or more NCI CCs overall (P = .002 for 1996-2002; P < .001 for 2003-2011) and by race for whites (hazard ratio [HR] for 1996-2002, 0.85; 95% confidence interval [CI], 0.78-0.91; HR for 2003-2011, 0.85; 95% CI, 0.79-0.91) but not for nonwhites. For NCCN access, improvement was seen in 1996-2002 (P = .003), in 2003-2011 (P < .001), and by race for whites (HR, 0.917; 95% CI, 0.88-0.95) and nonwhites (0.94; 95% CI, 0.89-0.99), but within nonwhites, this was true only for African Americans (AAs; HR, 0.88; 95% CI, 0.81-0.97) and not for Asians, Hispanics, or Native Americans. CONCLUSIONS Improvement in OS was seen in MM patients diagnosed after 1995 with access to 1 NCCN CC or 2 or more NCI CCs. NCI access benefited only whites, whereas NCCN access benefited only white and AA patients. No OS benefit was seen for any subgroup with access to only 1 NCI center. Eliminating racial disparities in health care access and utilization is needed to improve outcomes.
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Affiliation(s)
| | - Pooja Advani
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Dongyun Yang
- Department of Biostatistics, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Radhika Ghosh
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida.,Department of Pediatrics, Staten Island University Hospital, Staten Island, New York
| | - Abhisek Swaika
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Vivek Roy
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - James Foran
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Asher Chanan-Khan
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
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94
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Wolfson JA, Sun CL, Wyatt LP, Hurria A, Bhatia S. Impact of care at comprehensive cancer centers on outcome: Results from a population-based study. Cancer 2015; 121:3885-93. [PMID: 26218755 PMCID: PMC4892698 DOI: 10.1002/cncr.29576] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/21/2015] [Accepted: 05/29/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rigorous processes ensure quality of research and clinical care at National Cancer Institute-designated comprehensive cancer centers (NCICCCs). Unmeasurable elements of structure and process of cancer care delivery warrant evaluation. To the authors' knowledge, the impact of NCICCC care on survival and access to NCICCCs for vulnerable subpopulations remain unstudied. METHODS The current study's population-based cohort of 69,579 patients had newly diagnosed adult-onset (aged 22-65 years) cancers reported to the Los Angeles County cancer registry between 1998 and 2008. Geographic information systems were used for geospatial analysis. RESULTS With regard to overall survival across multiple diagnoses, patients not receiving their first planned treatment at NCICCCs experienced poorer outcomes compared with those treated at NCICCCs; differences persisted on multivariable analyses after adjusting for clinical and sociodemographic factors (hepatobiliary: hazard ratio [HR], 1.5; 95% confidence interval [95% CI], 1.4-1.7 [P<.001]; lung: HR, 1.4; 95% CI, 1.3-1.6 [P<.001]; pancreatic: HR, 1.5; 95% CI, 1.3-1.7 [P<.001]; gastric: HR, 1.3; 95% CI, 1.1-1.7 [P = .01]; breast: HR, 1.3; 95% CI, 1.1-1.5 [P<.001]; and colorectal: HR, 1.2; 95% CI, 1.0-1.4 [P = .05]). With regard to barriers to care, multivariable analyses revealed that a lower likelihood of treatment at NCICCCs was associated with race/ethnicity (African-American: OR range across diagnoses: 0.4-0.7 [P<.03]; Hispanic: OR range, 0.5-0.7 [P<.04]); lack of private insurance (public: OR range, 0.6-0.8 [P<.004]; uninsured: OR range, 0.1-0.5 [P<.04]); less than high socioeconomic status (high-middle: OR range, 0.4-0.7 [P<.02]; middle: OR range, 0.3-0.5 [P<.001]; and low: OR range, 0.2-0.6 [P<.01]), and residing >9 miles from the nearest NCICCC (OR range, 0.5-0.7 [P<.02]). CONCLUSIONS Among individuals aged 22 to 65 years residing in Los Angeles County with newly diagnosed adult-onset cancer, those who were treated at NCICCCs experienced superior survival compared with those treated at non-NCICCC facilities. Barriers to care at NCICCCs included race/ethnicity, insurance, socioeconomic status, and distance to an NCICCC.
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Affiliation(s)
- Julie A Wolfson
- Department of Population Sciences, City of Hope, Duarte, California
| | - Can-Lan Sun
- Department of Population Sciences, City of Hope, Duarte, California
| | - Laura P Wyatt
- Department of Population Sciences, City of Hope, Duarte, California
| | - Arti Hurria
- Department of Population Sciences, City of Hope, Duarte, California
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Smita Bhatia
- Department of Population Sciences, City of Hope, Duarte, California
- Department of Pediatrics, University of Alabama Birmingham, Birmingham, Alabama
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95
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Kong AL, Pezzin LE, Nattinger AB. Identifying patterns of breast cancer care provided at high-volume hospitals: a classification and regression tree analysis. Breast Cancer Res Treat 2015; 153:689-98. [DOI: 10.1007/s10549-015-3561-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/20/2015] [Indexed: 11/30/2022]
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96
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Amini N, Spolverato G, Kim Y, Pawlik TM. Trends in Hospital Volume and Failure to Rescue for Pancreatic Surgery. J Gastrointest Surg 2015; 19:1581-92. [PMID: 25794484 DOI: 10.1007/s11605-015-2800-9] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/08/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND We sought to evaluate trends in selection of high volume (HV) hospitals for pancreatic surgery, as well as examine trends in preoperative complications, mortality, and failure to rescue (FTR). METHOD Patients who underwent pancreatic resection between 2000 and 2011 were identified from the Nationwide Inpatient Sample (NIS). Preoperative morbidity, mortality, and FTR were examined over time. Hospital volume was stratified into tertiles based on the number of pancreatic resections per year for each time period. Logistic regression models were used to assess the effect of hospital volume on risk of complication, postoperative mortality, and FTR over time. RESULT A total of 35,986 patients were identified. Median hospital volume increased from 13 in 2000-2003 to 55 procedures/year in 2008-2011 (P < 0.001). Morbidity remained relatively the same over time at low volume (LV), intermediate volume (IV), and HV hospitals (all P > 0.05). Overall postoperative mortality was 5%, and it decreased over time across all hospital volumes (P < 0.05). FTR was more common at LV (12.0%) and IV (8.5%) volume hospitals compared with HV hospitals (6.4%). The improvement in FTR over time was most pronounced at LV and IV hospitals versus HV hospitals (P = 0.001). CONCLUSION Median hospital volume for pancreatic surgery has increased over the past decade. While the morbidity remained relatively stable over time, mortality improved especially in LV and IV hospitals. This improvement in mortality seems to be related to a decreased FTR.
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Affiliation(s)
- Neda Amini
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA
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97
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Roghmann F, Ravi P, Hanske J, Meyer CP, Preston MA, Noldus J, Trinh QD. Perioperative outcomes after radical cystectomy at NCI-designated centres: Are they any better? Can Urol Assoc J 2015. [PMID: 26225174 DOI: 10.5489/cuaj.2621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION In 1971, the National Cancer Institute (NCI) introduced a network of NCI-designated Cancer Centers (CC), which underwent a comprehensive approval process relying on research, education and prevention activities. In this study, we examine the effect of CC status on perioperative outcomes after radical cystectomy (RC). METHODS Within the Nationwide Inpatient Sample, we focused on RC performed from 2006 to 2010. As all recognized centres were residency teaching institutions, we stratified according to teaching and CC-teaching status. We examined the rates of in-hospital mortality, intra- and postoperative complications, prolonged length of hospital stay, as well as blood transfusion. Multivariable logistic regression analyses were further adjusted for confounding factors. RESULTS Overall, 22 840 RC patients (5451 at non-teaching, 10 857 at residency teaching, 6532 at CC-teaching institutions) were identified. Patients treated at residency teaching and CC-teaching institutions were younger, had less comorbidities, and more likely to have private insurance. In multivariable analyses, patients treated at residency and CC-teaching institutions were less likely to experience postoperative complications (odds ratio [OR] 0.73 and 0.66, respectively) and blood transfusions (OR 0.77 and 0.53, respectively) relative to patients treated at non-teaching institutions. In addition, CC patients were also less likely to experience in-hospital mortality (OR 0.61, all p < 0.001) as compared to non-teaching institutions. CONCLUSIONS On average, patients treated at residency and CC-teaching institutions are less likely to experience unfavourable outcomes after RC. Moreover, patients treated at CC fared better than patients treated at residency teaching institutions. Our findings acknowledge the quality of RC care at accredited centres.
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Affiliation(s)
- Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Praful Ravi
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Julian Hanske
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA ; Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Christian P Meyer
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mark A Preston
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Joachim Noldus
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health and Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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98
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Balasubramaniam R, Subesinghe M, Smith JT. The proliferation of multidisciplinary team meetings (MDTMs): how can radiology departments continue to support them all? Eur Radiol 2015; 25:3679-84. [DOI: 10.1007/s00330-015-3760-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 03/26/2015] [Accepted: 04/01/2015] [Indexed: 02/06/2023]
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99
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Veenstra CM, Epstein AJ, Liao K, Griggs JJ, Pollack CE, Armstrong K. Hospital academic status and value of care for nonmetastatic colon cancer. J Oncol Pract 2015; 11:e304-12. [PMID: 25901052 PMCID: PMC5706144 DOI: 10.1200/jop.2014.003137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The relationship between oncologic hospital academic status and the value of care for stage II and III colon cancer is unknown. METHODS Retrospective SEER-Medicare analysis of patients age ≥ 66 years with stage II or III colon cancer and seen by medical oncology. Eligible patients were diagnosed 2000 to 2009 and followed through December 31, 2010. Hospitals reporting a major medical school affiliation in the NCI Hospital File were classified as academic medical centers. The association between hospital academic status and survival was assessed using Kaplan-Meier curves and Cox proportional hazards models. The association with mean cost of care was estimated using generalized linear models with log link and gamma family and with cost of care at various quantiles using quantile regression models. RESULTS Of 24,563 eligible patients, 5,707 (23%) received care from academic hospitals. There were no significant differences in unadjusted disease-specific median survival or adjusted risk of colon cancer death by hospital academic status (stage II hazard ratio = 1.12; 95% CI, 0.98 to 1.28; P = .103; stage III hazard ratio = 0.99; 95% CI, 0.90 to 1.08; P = .763). Excepting patients at the upper limits of the cost distribution, there was no significant difference in adjusted cost by hospital academic status. CONCLUSION We found no survival differences for elderly patients with stage II or III colon cancer, treated by a medical oncologist, between academic and nonacademic hospitals. Furthermore, cost of care was similar across virtually the full range of the cost distribution.
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Affiliation(s)
- Christine M Veenstra
- University of Michigan, Ann Arbor, MI; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD; and Massachusetts General Hospital, Boston, MA
| | - Andrew J Epstein
- University of Michigan, Ann Arbor, MI; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD; and Massachusetts General Hospital, Boston, MA
| | - Kaijun Liao
- University of Michigan, Ann Arbor, MI; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD; and Massachusetts General Hospital, Boston, MA
| | - Jennifer J Griggs
- University of Michigan, Ann Arbor, MI; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD; and Massachusetts General Hospital, Boston, MA
| | - Craig E Pollack
- University of Michigan, Ann Arbor, MI; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD; and Massachusetts General Hospital, Boston, MA
| | - Katrina Armstrong
- University of Michigan, Ann Arbor, MI; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD; and Massachusetts General Hospital, Boston, MA
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100
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Lin TL, Williams T, He J, Aljitawi OS, Ganguly S, Abhyankar S, Fleming A, Male H, McGuirk JP. Rates of complete diagnostic testing for patients with acute myeloid leukemia. Cancer Med 2015; 4:519-22. [PMID: 25620650 PMCID: PMC4402066 DOI: 10.1002/cam4.406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/05/2014] [Accepted: 12/05/2014] [Indexed: 12/17/2022] Open
Abstract
In addition to cytogenetics, additional molecular markers of prognosis have been identified and incorporated into the management of patients with acute myeloid leukemia (AML). We hypothesized that rates of molecular testing would be higher in an academic center versus community sites. A retrospective chart review included all de novo AML patients (excluding M3) at Kansas University Medical Center (KUMC) from January 2008 through April 2013. Records were evaluated for completeness of molecular testing as indicated by karyotype (FLT3, CEBPα, NPM1 in normal cytogenetics AML and c-KIT in core binding factor [CBF] AML). 271 charts were reviewed: 98 with CN-AML and 29 with CBF AML. Seventy were diagnosed at KUMC, 57 at a community site. Molecular testing was sent in 76/98 (77%) patients with CN-AML. Patients diagnosed at KUMC had a significantly higher rate of molecular testing (51/55, 93%) as compared to those diagnosed at outside centers (18/43, 41%) (P < 0.001). Of 29 patients with CBF AML, c-kit mutational analysis was performed more frequently at KUMC (14/15, 93%) than in community sites (8/14, 57%) (P = 0.035). There was a trend towards increased testing at both KUMC and community sites in later years. Rates of molecular testing in AML were higher in an academic center versus community sites in the 5 years following the World Health Organization revised classification of AML. All physicians who diagnose and treat AML must remain up to date on the latest recommendations and controversies in molecular testing in order to appropriately risk stratify patients and determine optimal therapy.
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Affiliation(s)
- Tara L Lin
- Division of Hematology/Oncology, Department of Internal Medicine, University of Kansas School of Medicine3901 Rainbow Blvd., Kansas City, Kansas, 66210
| | - Travis Williams
- Division of Hematology/Oncology, Department of Internal Medicine, University of Kansas School of Medicine3901 Rainbow Blvd., Kansas City, Kansas, 66210
| | - Jianghua He
- Department of Biostatistics, University of Kansas School of Medicine3901 Rainbow Blvd., Kansas City, Kansas, 66210
| | - Omar S Aljitawi
- Division of Hematology/Oncology, Department of Internal Medicine, University of Kansas School of Medicine3901 Rainbow Blvd., Kansas City, Kansas, 66210
| | - Siddhartha Ganguly
- Division of Hematology/Oncology, Department of Internal Medicine, University of Kansas School of Medicine3901 Rainbow Blvd., Kansas City, Kansas, 66210
| | - Sunil Abhyankar
- Division of Hematology/Oncology, Department of Internal Medicine, University of Kansas School of Medicine3901 Rainbow Blvd., Kansas City, Kansas, 66210
| | - Allan Fleming
- Division of Hematology/Oncology, Department of Internal Medicine, University of Kansas School of Medicine3901 Rainbow Blvd., Kansas City, Kansas, 66210
| | - Heather Male
- Division of Hematology/Oncology, Department of Internal Medicine, University of Kansas School of Medicine3901 Rainbow Blvd., Kansas City, Kansas, 66210
| | - Joseph P McGuirk
- Division of Hematology/Oncology, Department of Internal Medicine, University of Kansas School of Medicine3901 Rainbow Blvd., Kansas City, Kansas, 66210
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