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Prost P, Duraes M, Georgescu V, Rebel L, Mercier G, Rathat G. Impact of Ovarian Cancer Surgery Volume on Overall and Progression-Free Survival: A Population-Based Retrospective National French Study. Ann Surg Oncol 2024; 31:3269-3279. [PMID: 38393461 DOI: 10.1245/s10434-024-15050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Data are limited on the relationship between ovarian cancer surgery volume and outcomes in France. METHODS For this retrospective, population-based study, patients with ovarian cancer that was diagnosed between January 1, 2012 and December 31, 2016 were identified from the French National Health Data System (SNDS). Hospitals were classified in function of their ovarian cancer surgery volume. Patient, tumor, hospital, and hospital stay characteristics also were evaluated. The hospital procedure volume effect on 5-year overall survival (OS) and recurrence-free survival (RFS) was determined with Cox-proportional hazards models. RESULTS This study included 8429 patients and 53.4% underwent cytoreductive surgery in hospitals with procedure volume < 20 cases/year. The 5-year OS rates were 63% and 60% in hospitals with procedure volume ≥ 20 and < 20 cases/year (p = 0.02). In multivariate analysis, OS and RFS were significantly increased when surgery was performed in hospitals doing ≥ 20 surgeries/year (vs. < 20) (hazard ratio HR = 1.18, 95% CI = 1.08-1.29 and HR = 1.10, 95% CI = 1.03-1.17). In the volume subgroup analysis, a difference was observed mainly between hospitals with < 10 surgeries/year and the other hospitals (HR = 1.27, 95% CI = 1.14-1.41 and HR = 1.14, 95% CI = 1.05-1.23). The patients' age and comorbidities, tumor stage, and hospital stay (duration, first cytoreduction surgery) were associated with OS. CONCLUSIONS Ovarian cancer surgery volume ≥ 20 cases/year was significantly associated with improved OS and RFS but only with a limited clinical benefit. The biggest differences in OS and RFS were observed between hospitals with procedure volume < 10 cases/year and all the other hospitals.
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Affiliation(s)
- Pauline Prost
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France.
| | - Martha Duraes
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Vera Georgescu
- Health Data Science Unit, Montpellier University Hospital and UMR IDESP, INSERM, Montpellier University, Montpellier, France
| | - Lucie Rebel
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Grégoire Mercier
- Health Data Science Unit, Montpellier University Hospital and UMR IDESP, INSERM, Montpellier University, Montpellier, France
| | - Gauthier Rathat
- Department of Gynecological and Breast Surgery, Montpellier University Hospital, Montpellier, France
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Meurette J, Daraï E, Tajahmady A, Fouard A, Ducastel A, Collin-Bund V, Jochum F, Lecointre L, Querleu D, Akladios C. [Arguments for centralization of surgical treatment of ovarian cancer in France based on morbidity and mortality data]. Bull Cancer 2024; 111:239-247. [PMID: 36797128 DOI: 10.1016/j.bulcan.2022.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To examine the current state for ovarian cancer surgery in France from 2009 to 2016 and to examine the impact of the volume of activity on morbidity and mortality by institution. MATERIAL AND METHOD National retrospective study analyzing surgical sessions for ovarian cancer from the program of medicalization of information systems (PMSI), from January 2009 to December 2016. Institutions were divided according to the number of annual curative procedures into 3 groups: A<10; B: 10-19; C≥20. A propensity score (PS) and the Kaplan-Meier method were employed for statistical analyses. RESULTS In total, 27,105 patients were included. The 1-month mortality rate in group A, B and C was 1.6; 1 and 0.7 %, respectively (P<0.001). Compared to group C, the Relative Risk (RR) of death within the first month was 2.22 for group A and 1.32 for group B (P<0.01). After MS, the 3- and 5-year survival in group A+B and group C were 71.4 and 60.3% (P<0.05) and 56.6, and 60.3% (P<0.05), respectively. The 1-year recurrence rate was significantly lower in group C (P<0.0001). CONCLUSION An annual volume of activity>20 advanced stage ovarian cancers is associated with a decrease in morbidity, mortality, recurrence rate and improved survival.
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Affiliation(s)
- Jacques Meurette
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Emile Daraï
- Hôpital Tenon, service de gynécologie-obstétrique, Paris, France
| | - Ayden Tajahmady
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Annie Fouard
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Anne Ducastel
- Caisse nationale d'assurance maladie, 50, avenue du Pr André-Lemierre, 93170 Paris, France
| | - Virginie Collin-Bund
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Floriane Jochum
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Lise Lecointre
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Denis Querleu
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France
| | - Chérif Akladios
- Hôpitaux universitaires de Strasbourg, service de gynécologie-obstétrique, Strasbourg, France.
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Savoye I, Silversmit G, Bourgeois J, De Gendt C, Leroy R, Peacock HM, Stordeur S, de Sutter P, Goffin F, Luyckx M, Orye G, Van Dam P, Van Gorp T, Verleye L. Association between hospital volume and outcomes in invasive ovarian cancer in Belgium: A population-based study. Eur J Cancer 2023; 195:113402. [PMID: 37922631 DOI: 10.1016/j.ejca.2023.113402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/28/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To study the association between hospital volume and outcomes in patients with invasive epithelial ovarian cancer (EOC). METHODS This study included 3988 patients diagnosed with invasive EOC between 2014 and 2018, selected from the population-based database of the Belgian Cancer Registry (BCR), and coupled with health insurance and vital status data. The associations between hospital volume and observed survival since diagnosis were assessed with Cox proportional hazard models, while volume associations with 30-day post-operative mortality and complicated recovery were evaluated using logistic regression models. RESULTS Treatment for EOC was very dispersed with half of the 100 centres treating fewer than six patients per year. The median survival of patients treated in centres with the highest-volume quartile was 2.5 years longer than in those with the lowest-volume quartile (4.2 years versus 1.7 years). When taking the case-mix of hospitals into account, patients treated in the lowest volume centres had a 47% higher hazard to die than patients treated in the highest volume centres (HR: 1.47, 95% CI: 1.11-1.93, p = 0.006) over the first five years after incidence. A similar association was found when focussing on the surgical volume of the hospitals and considering only operated patients with invasive EOC. Lastly, the 30-day post-operative mortality decreased significantly with increasing surgical volume. CONCLUSIONS The large dispersion of care and expertise within Belgium and the volume-outcome associations observed in this study support the implementation of the concentration of care for patients with invasive EOC in reference centres.
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Affiliation(s)
- Isabelle Savoye
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
| | | | | | | | - Roos Leroy
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Sabine Stordeur
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | | | - Frédéric Goffin
- Obstetrics and Gynecology, University of Liege, Liege, Belgium
| | - Mathieu Luyckx
- Service de gynécologie et Andrologie and Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Guy Orye
- Department of Obstetrics and Gynecology, Jessa Hospital, Hasselt, Belgium
| | - Peter Van Dam
- Division of Gynecologic Oncology, Multidisciplinary Oncologic Center, Antwerp University Hospital, Edegem, Belgium
| | - Toon Van Gorp
- University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Leen Verleye
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
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4
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Sato Y, Kaneko R, Yano Y, Kamada K, Kishimoto Y, Ikehara T, Sato Y, Matsuda T, Igarashi Y. Volume-Outcome Relationship in Cancer Survival Rates: Analysis of a Regional Population-Based Cancer Registry in Japan. Healthcare (Basel) 2022; 11:healthcare11010016. [PMID: 36611476 PMCID: PMC9819082 DOI: 10.3390/healthcare11010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is limited data on the relationship between hospital volumes and outcomes with respect to cancer survival in Japan. The primary objective of this study was to evaluate the effect of hospital volume on cancer survival rate using a population-based cohort database. METHODS Using the Kanagawa cancer registry, propensity score matching was employed to create a dataset for each cancer type by selecting 1:1 matches for cases from high- and other-volume hospitals. The 5-year survival rate was estimated and the hazard ratio (HR) for hospital volume was calculated using a Cox proportional hazard model. Additional analyses were performed limited to cancer patients who underwent surgical operation, chemotherapy, and other treatments in each tumor stage and at the time of diagnosis. RESULTS The number of cases with complete data, defined as common cancers (prostate, kidney, bladder, esophagus, stomach, liver, pancreas, colon, breast, and lung), was 181,039. Adjusted HR differed significantly among hospital volume categories for the most common cancers except bladder, and the trends varied according to cancer type. The HR ranged from 0.76 (95%CI, 0.74-0.79) for stomach cancer to 0.85 (0.81-0.90) for colon cancer. CONCLUSIONS This study revealed that a relationship may exist between hospital volume and cancer survival in Japan.
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Affiliation(s)
- Yoichiro Sato
- Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Kanagawa 211-8510, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo 143-8541, Japan
| | - Rena Kaneko
- Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Kanagawa 211-8510, Japan
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
- Correspondence: ; Tel.: +81-44-433-3150
| | - Yuichiro Yano
- Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Kanagawa 211-8510, Japan
| | - Kentaro Kamada
- Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Kanagawa 211-8510, Japan
| | - Yuui Kishimoto
- Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Kanagawa 211-8510, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo 143-8541, Japan
| | - Takashi Ikehara
- Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Kanagawa 211-8510, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo 143-8541, Japan
| | - Yuzuru Sato
- Department of Gastroenterology and Hepatology, Kanto Rosai Hospital, Kanagawa 211-8510, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo 143-8541, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo 143-8541, Japan
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Frost AS, Smith AJB, Fader AN, Wethington SL. Modifiable risk factors associated with long-term survival in women with serous ovarian cancer: a National Cancer Database study. Int J Gynecol Cancer 2022; 32:769-780. [PMID: 35459709 DOI: 10.1136/ijgc-2021-003323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify patient, clinical and hospital factors associated with long-term survival (≥10 years) in women with serous ovarian cancer. METHODS This National Cancer Database cohort study included women with stage II-IV serous ovarian cancer. Multivariate logistic regression models were used to examine the association of long-term survival with patient (race, insurance, location, household income, education, distance traveled), clinical (age, comorbidities, stage, grade, primary treatment) and hospital factors (region, institution, hospital volume ≥20). RESULTS Of the 4640 women identified, 12% (n=561) experienced long-term survival. Median overall survival was 41 months (95% CI 39 to 42). The odds of long-term survival were lower for women with public or no insurance (adjusted OR 0.71, 95% CI 0.55 to 0.92), age ≥75 years (0.33, 0.22 to 0.50), any comorbidities (0.70, 0.54 to 0.92), higher stage (stage III: 0.31, 0.25 to 0.41; stage IV: 0.16, 0.12 to 0.22), and moderately/poorly differentiated, undifferentiated, or tumors of unknown grade (moderately/poorly differentiated: 0.30, 0.20 to 0.47; undifferentiated: 0.28, 0.17 to 0.47; unknown: 0.30, 0.18 to 0.50). The odds of long-term survival among women who were publicly insured were lower with neoadjuvant chemotherapy (0.13, 0.04 to 0.044) and higher with optimal cytoreduction (2.24, 1.49 to 3.36). Among women who were privately insured, the odds of long-term survival were higher with optimal cytoreduction (1.99, 1.46 to 2.70) and unaffected by neoadjuvant chemotherapy. CONCLUSIONS While immutable clinical factors such as age, stage, and grade are associated with long-term survival in women with serous ovarian cancer, modifiable factors, such as insurance type, optimal cytoreductive status, and neoadjuvant chemotherapy provide an opportunity for targeted improvement in care with potential to affect long-term patient outcomes.
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Affiliation(s)
- Anja Sophia Frost
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Anna Jo Bodurtha Smith
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania, USA
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Stephanie L Wethington
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Concin N, Planchamp F, Abu-Rustum NR, Ataseven B, Cibula D, Fagotti A, Fotopoulou C, Knapp P, Marth C, Morice P, Querleu D, Sehouli J, Stepanyan A, Taskiran C, Vergote I, Wimberger P, Zapardiel I, Persson J. European Society of Gynaecological Oncology quality indicators for the surgical treatment of endometrial carcinoma. Int J Gynecol Cancer 2021; 31:1508-1529. [PMID: 34795020 DOI: 10.1136/ijgc-2021-003178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Quality of surgical care as a crucial component of a comprehensive multi-disciplinary management improves outcomes in patients with endometrial carcinoma, notably helping to avoid suboptimal surgical treatment. Quality indicators (QIs) enable healthcare professionals to measure their clinical management with regard to ideal standards of care. OBJECTIVE In order to complete its set of QIs for the surgical management of gynecological cancers, the European Society of Gynaecological Oncology (ESGO) initiated the development of QIs for the surgical treatment of endometrial carcinoma. METHODS QIs were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for the identification of potential QIs and documentation of the scientific evidence, two consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians and patient representatives. QIs were defined using a structured format comprising metrics specifications, and targets. A scoring system was then developed to ensure applicability and feasibility of a future ESGO accreditation process based on these QIs for endometrial carcinoma surgery and support any institutional or governmental quality assurance programs. RESULTS Twenty-nine structural, process and outcome indicators were defined. QIs 1-5 are general indicators related to center case load, training, experience of the surgeon, structured multi-disciplinarity of the team and active participation in clinical research. QIs 6 and 7 are related to the adequate pre-operative investigations. QIs 8-22 are related to peri-operative standards of care. QI 23 is related to molecular markers for endometrial carcinoma diagnosis and as determinants for treatment decisions. QI 24 addresses the compliance of management of patients after primary surgical treatment with the standards of care. QIs 25-29 highlight the need for a systematic assessment of surgical morbidity and oncologic outcome as well as standardized and comprehensive documentation of surgical and pathological elements. Each QI was associated with a score. An assessment form including a scoring system was built as basis for ESGO accreditation of centers for endometrial cancer surgery.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria .,Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | | | - Nadeem R Abu-Rustum
- Department of Obstetrics and Gynecology, Memorial Sloann Kettering Cancer Center, New York, New York, USA
| | - Beyhan Ataseven
- Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynaecology, University Hospital Munich (LMU), Munich, Germany
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | - Pawel Knapp
- Department of Gynaecology and Gynaecologic Oncology, University Oncology Center of Bialystok, Medical University of Bialystok, Bialystok, Poland
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Artem Stepanyan
- Department of Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Ankara, Turkey.,Department of Gynecologic Oncology, VKV American Hospital, Istambul, Turkey
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Jan Persson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden.,Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
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7
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Alejandra M, Gertych W, Pomel C, Ferron G, Lusque A, Angeles MA, Lambaudie E, Rouzier R, Bakrin N, Golfier F, Glehen O, Canis M, Bourdel N, Pouget N, Colombo PE, Guyon F, Meurette J, Querleu D. Adherence to French and ESGO Quality Indicators in Ovarian Cancer Surgery: An Ad-Hoc Analysis from the Prospective Multicentric CURSOC Study. Cancers (Basel) 2021; 13:cancers13071593. [PMID: 33808284 PMCID: PMC8037412 DOI: 10.3390/cancers13071593] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Quality Indicators for ovarian cancer (OC) have been developed by the European Society of Gynaecological Oncology (ESGO) and by the French National Cancer Institute (Institut National du Cancer, INCa). The aim of the study was to characterize OC care distribution in France by case-volume and to prospectively evaluate the adherence of high-volume institutions to INCa/ESGO quality indicators. METHODS The cost-utility of radical surgery in ovarian cancer (CURSOC) trial is a prospective, multicenter, comparative and non-randomized study that includes patients with stage IIIC-IV epithelial OC treated in nine French health care tertiary institutions. Adherence to institutional quality indicators were anonymously assessed by an independent committee. OC care distribution in France were provided by the nationwide database of hospital procedures. RESULTS More than half of patients are treated in low-volume institutions. Among the nine high-volume centers participating in the study, four (44.4%) met all institutional INCa/ESGO quality indicators. The other five (55.6%) did not fulfil one of the quality indicator criteria. CONCLUSIONS Access to high-volume OC providers in France is restricted to a minority of patients, and yet half of the referral institutions included in this study failed to meet all recommended institutional quality indicators. It is mandatory that national authorities work both to improve OC centralization and to incorporate quality assurance programs into certified centers.
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Affiliation(s)
- Martinez Alejandra
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer—Toulouse Oncopole, 59500 Toulouse, France; (G.F.); (M.A.A.)
- Cancer Research Center of Toulouse (CRCT), INSERM UMR 1037, 31037 Toulouse, France
- Correspondence:
| | - Witold Gertych
- Obstetrics and Gynecology Department, University Hospital Lyon Sud, 69008 Lyon, France; (W.G.); (F.G.)
| | - Christophe Pomel
- Surgical Oncology Department, Centre Jean Perrin, 63000 Clermont Ferrand, France;
| | - Gwenael Ferron
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer—Toulouse Oncopole, 59500 Toulouse, France; (G.F.); (M.A.A.)
- Cancer Research Center of Toulouse (CRCT), INSERM UMR 1037, 31037 Toulouse, France
| | - Amelie Lusque
- Biostatistics Department, Institut Claudius Regaud, Institut Universitaire du Cancer—Toulouse Oncopole, 59500 Toulouse, France;
| | - Martina Aida Angeles
- Surgical Oncology Department, Institut Claudius Regaud, Institut Universitaire du Cancer—Toulouse Oncopole, 59500 Toulouse, France; (G.F.); (M.A.A.)
| | - Eric Lambaudie
- Surgical Oncology Department, Institut Paoli Calmettes, 13009 Marseille, France;
| | - Roman Rouzier
- Surgical Oncology Department, Institut Curie, 75248 Paris, France; (R.R.); (N.P.)
| | - Naoual Bakrin
- Visceral and Digestive Surgery, University Hospital of Lyon Sud, 69008 Lyon, France; (N.B.); (O.G.)
| | - Francois Golfier
- Obstetrics and Gynecology Department, University Hospital Lyon Sud, 69008 Lyon, France; (W.G.); (F.G.)
| | - Olivier Glehen
- Visceral and Digestive Surgery, University Hospital of Lyon Sud, 69008 Lyon, France; (N.B.); (O.G.)
| | - Michel Canis
- Obstetrics and Gynecology, University Hospital Clermont Ferrand, 63000 Clermont Ferrand, France; (M.C.); (N.B.)
| | - Nicolas Bourdel
- Obstetrics and Gynecology, University Hospital Clermont Ferrand, 63000 Clermont Ferrand, France; (M.C.); (N.B.)
| | - Nicolas Pouget
- Surgical Oncology Department, Institut Curie, 75248 Paris, France; (R.R.); (N.P.)
| | | | - Frédéric Guyon
- Surgical Oncology, Institut Bergonié, 33000 Bordeaux, France;
| | | | - Denis Querleu
- Department of Gynecologic Oncology, Agostino Gemelli University Hospital, 00168 Rome, Italy;
- Department of Obstetrics and Gynecology, University Hospital of Strasbourg, 67091 Strasbourg, France
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8
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Taniyama Y, Tabuchi T, Ohno Y, Morishima T, Okawa S, Koyama S, Miyashiro I. Hospital Surgical Volume and 3-Year Mortality in Severe Prognosis Cancers: A Population-Based Study Using Cancer Registry Data. J Epidemiol 2021; 31:52-58. [PMID: 31932528 PMCID: PMC7738649 DOI: 10.2188/jea.je20190242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The impact of hospital surgical volume on long-term mortality has not been well assessed in Japan, especially for esophageal, biliary tract, and pancreatic cancer, although these three cancers need a high level of medical-technical skill. The purpose of this study was to examine associations between hospital surgical volume and 3-year mortality for these severe-prognosis cancer patients. METHODS Patients who received curative surgery for esophageal, biliary tract, and pancreatic cancers were analyzed using the Osaka Cancer Registry data from 2006-2013. Hospital surgical volume was categorized into tertiles (high/middle/low) according to the average annual number of curative surgeries per hospital for each cancer. Three-year survivals were calculated using the Kaplan-Meier method. Hazard ratios (HRs) of 3-year mortality were calculated using Cox proportional hazard models, adjusting for patient characteristics. RESULTS Three-year survival was higher with increased hospital surgical volume for all three cancers, but the relative importance of volume varied across sites. After adjustment for all confounding factors, HRs in middle- and low-volume hospitals were 1.34 (95% confidence interval [CI], 1.14-1.58) and 1.57 (95% CI, 1.33-1.86) for esophageal cancer; 1.39 (95% CI, 1.15-1.67) and 1.57 (95% CI, 1.30-1.89) for biliary tract cancer; 1.38 (95% CI, 1.16-1.63) and 1.90 (95% CI, 1.60-2.25) for pancreatic cancer, respectively. In particular for localized pancreatic cancer, the impact of hospital surgical volume on 3-year mortality was strong (HR 2.66; 95% CI, 1.61-4.38). CONCLUSION We suggest that patients who require curative surgery for esophageal, biliary tract, and pancreatic cancer may benefit from referral to high-volume hospitals.
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Affiliation(s)
- Yukari Taniyama
- Department of Mathematical Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yuko Ohno
- Department of Mathematical Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Shihoko Koyama
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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9
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Okawa S, Tabuchi T, Morishima T, Koyama S, Taniyama Y, Miyashiro I. Hospital volume and postoperative 5-year survival for five different cancer sites: A population-based study in Japan. Cancer Sci 2020; 111:985-993. [PMID: 31943492 PMCID: PMC7060475 DOI: 10.1111/cas.14309] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/11/2019] [Accepted: 12/27/2019] [Indexed: 01/10/2023] Open
Abstract
The relationship between hospital volume and patient outcome is globally known; thus, hospital volume is widely used as a quality indicator. In Japan, however, recent studies on this topic are scarce. The present study examined whether hospital surgery volume is associated with postoperative 5-year survival among cancer patients. Using the Osaka Cancer Registry, we identified a sample of 86 145 patients who were diagnosed with cancer at any of five different sites (stomach, colorectum, lung, breast and uterus) and underwent surgeries between 2007 and 2011 in Osaka. We ranked hospitals by annual surgical volume, sorted patients in descending order by hospital volume, and assigned them into quartiles (high, medium, low and very low volume). We analyzed the association between hospital volume and 5-year survival among 80 959 patients aged between 15 and 84 years using Cox proportional hazard models. Adjustments were made for characteristics of patients, type of surgery and adjuvant treatment received. The mortality hazard of patients treated at very low-volume hospitals was 1.36-1.82-fold higher than that of patients treated at high-volume hospitals. Absolute differences in adjusted survival rates between high-volume and very low-volume hospitals varied with the cancer site: 14.9 in stomach, 11.5 in colorectal, 10.8 in lung, 2.4 in breast and 3.3 in uterine cancers. Hospitals with lower surgery volumes showed higher mortality risks after cancer surgery than those with higher volumes. Monitoring site-specific surgery volumes and referring patients from low-volume to high-volume hospitals may be beneficial for improving the long-term survival of cancer patients.
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Affiliation(s)
- Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Shihoko Koyama
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Yukari Taniyama
- Department of Mathematical Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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10
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Le T, Giede C. No. 230-Initial Evaluation and Referral Guidelines for Management of Pelvic/Ovarian Masses. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018. [DOI: 10.1016/j.jogc.2018.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Archivée: N° 230-Prise en charge des masses pelviennes / ovariennes : Évaluation initiale et lignes directrices quant à l'orientation des patientes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018. [DOI: 10.1016/j.jogc.2018.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Huguet M, Perrier L, Bally O, Benayoun D, De Saint Hilaire P, Beal Ardisson D, Morelle M, Havet N, Joutard X, Meeus P, Gabelle P, Provençal J, Chauleur C, Glehen O, Charreton A, Farsi F, Ray-Coquard I. Being treated in higher volume hospitals leads to longer progression-free survival for epithelial ovarian carcinoma patients in the Rhone-Alpes region of France. BMC Health Serv Res 2018; 18:3. [PMID: 29301572 PMCID: PMC5755403 DOI: 10.1186/s12913-017-2802-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France. METHODS This retrospective study using prospectively implemented databases was conducted on an exhaustive cohort of 267 patients undergoing first-line therapy during 2012 in the Rhone-Alpes Region of France. We compared Progression-Free Survival for Epithelial Ovarian Carcinoma patients receiving first-line therapy in high- (i.e. ≥ 12 cases/year) vs. low-volume hospitals. To control for selection bias, multivariate analysis and propensity scores were used. An adjusted Kaplan-Meier estimator and a univariate Cox model weighted by the propensity score were applied. RESULTS Patients treated in the low-volume hospitals had a probability of relapse (including death) that was almost two times (i.e. 1.94) higher than for patients treated in the high-volume hospitals (p < 0.001). CONCLUSION To our knowledge, this is the first study conducted in this setting in France. As reported in other countries, there was a significant positive association between greater volume of hospital care for EOC and patient survival. Other factors may also be important such as the quality of the surgical resection.
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Affiliation(s)
- Marius Huguet
- Univ Lyon, University Lumière Lyon 2, GATE L-SE UMR 5824, 93 Chemin des Mouilles, F-69130, Ecully, France.
| | - Lionel Perrier
- Univ Lyon, Léon Bérard Cancer Center, GATE L-SE UMR 5824, F-69008, Lyon, France
| | | | | | | | | | - Magali Morelle
- Univ Lyon, Léon Bérard Cancer Center, GATE L-SE UMR 5824, F-69008, Lyon, France
| | - Nathalie Havet
- Univ Lyon, University Claude Bernard Lyon 1, ISFA, Laboratoire SAF, F-69007, Lyon, France
| | - Xavier Joutard
- Lest-UMR 7317, Aix-Marseille University, Marseille, France
| | | | | | | | | | | | | | - Fadila Farsi
- Réseau Espace Santé Cancer Rhône-Alpes, Lyon, France
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13
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Aletti GD, Cliby WA. Time for centralizing patients with ovarian cancer: what are we waiting for? Gynecol Oncol 2017; 142:209-10. [PMID: 27452302 DOI: 10.1016/j.ygyno.2016.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/18/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Giovanni D Aletti
- Dept. Of Gynecologic Surgery, European Institute of Oncology, Milan, Italy.
| | - William A Cliby
- Professor Obstetrics and Gynecology, Virgil S. Counseller Professor of Surgery, Mayo Clinic, Rochester, MN.
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14
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Care Delivery Patterns, Processes, and Outcomes for Primary Ovarian Cancer Surgery: A Population-Based Review Using a National Administrative Database. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:25-33. [DOI: 10.1016/j.jogc.2016.09.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/20/2016] [Indexed: 11/18/2022]
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15
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Aletti GD, Peiretti M. Quality control in ovarian cancer surgery. Best Pract Res Clin Obstet Gynaecol 2016; 41:96-107. [PMID: 27806912 DOI: 10.1016/j.bpobgyn.2016.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/16/2022]
Abstract
The optimal surgical management of patients with ovarian cancer includes a thorough staging with peritoneal and retroperitoneal assessment for early disease stages and a complete debulking with the removal of all macroscopic tumor for advanced disease stages. Disparities across different institutions in terms of optimal surgical management have been described. Surgical quality control programs constitute a real possibility to ensure and improve the quality of the surgery performed. Guidelines for surgery in early and advanced disease stages have been recently reviewed by the National Comprehensive Cancer Network (NCCN), and several quality indicators (QIs) have been proposed. These QIs can be used as a powerful tool to monitor, compare, and improve the quality of surgery across different centers and institutions. Furthermore, a transparent report of surgical outcomes through the creation of National and International Networks, adherence to the NCCN guidelines, and the establishment of quality control programs with a strong training and education component are key factors in enhancing the quality of surgery for patients with ovarian cancer.
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Affiliation(s)
- Giovanni D Aletti
- Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
| | - Michele Peiretti
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Italy
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16
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Seror J, Guillot E, Genin AS, Hequet D, Pouget N, Dubot C, Rouzier R. [Effectiveness of "threshold" in the management of ovarian cancer: A review of the literature]. Bull Cancer 2016; 103:513-23. [PMID: 27238445 DOI: 10.1016/j.bulcan.2016.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 02/11/2016] [Accepted: 03/27/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The "Institut national du cancer" has established since 2007 a minimum threshold of 20 patients per year per center to treat patients with gynecologic cancer. This review aims to assess whether the literature data validate this approach, and specifically for ovarian cancer. METHODS A search of the MEDLINE database was conducted, to reference all relevant articles evaluating one hand the links between the survival of patients with ovarian cancer and the average volume of patients per center and by operator; and secondly the relationship between quality of oncological surgery and these volumes. RESULTS Nineteen studies met our inclusion criteria; seventeen were retrospective and two were prospective; population samples ranged from 476 to 96,802 patients. The most important data, quantitatively and qualitatively, concern the evaluation of survival based on the average volume per center, with 8 out of 13 studies finding a statistically significant correlation between average volume per center and survival. Data on the quality of surgery are less abundant and more heterogeneous, depending on the definition of the "optimal" surgery by the authors. CONCLUSION The establishment of threshold centers appears to be an effective way to improve survival in ovarian cancer. However, these thresholds would have to be specific to ovarian cancer and not extended to "gynecological cancers."
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Affiliation(s)
- Julien Seror
- Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France.
| | - Eugénie Guillot
- Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Anne-Sophie Genin
- Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Delphine Hequet
- Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France; Université Versailles-St-Quentin-en-Yvelines, EA 7285, risques cliniques et sécurité en santé des femmes et en santé périnatale, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Nicolas Pouget
- Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Coraline Dubot
- Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Roman Rouzier
- Université Versailles-Saint-Quentin-en-Yvelines, institut Curie, service de chirurgie cancérologique gynécologique et du sein, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France; Université Versailles-St-Quentin-en-Yvelines, EA 7285, risques cliniques et sécurité en santé des femmes et en santé périnatale, site René-Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France
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17
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Galvan-Turner VB, Chang J, Ziogas A, Bristow RE. Observed-to-expected ratio for adherence to treatment guidelines as a quality of care indicator for ovarian cancer. Gynecol Oncol 2015; 139:495-9. [PMID: 26387962 PMCID: PMC5145796 DOI: 10.1016/j.ygyno.2015.09.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop an observed-to-expected ratio (O/E) for adherence to National Comprehensive Cancer Network (NCCN) ovarian cancer treatment guidelines as a risk-adjusted hospital measure of quality care correlated with disease-specific survival. METHODS Consecutive patients with stages I-IV epithelial ovarian cancer were identified from the California Cancer Registry (1/1/96-12/31/06). Using a fit logistic regression model, O/E for guideline adherence was calculated for each hospital and distributed into quartiles stratified by hospital annual case volume: lowest O/E quartile or annual hospital case volume <5, middle two O/E quartiles and volume ≥5, and highest O/E quartile and volume ≥5. A multivariable logistic regression model was used to characterize the independent effect of hospital O/E on ovarian cancer-specific survival. RESULTS Overall, 18,491 patients were treated at 405 hospitals; 37.3% received guideline adherent care. Lowest O/E hospitals (n=285) treated 4661 patients (25.2%), mean O/E=0.77±0.55 and median survival 38.9months (95%CI=36.2-42.0months). Intermediate O/E hospitals (n=85) treated 8715 patients (47.1%), mean O/E=0.87±0.17 and median survival of 50.5months (95% CI=48.4-52.8months). Highest O/E hospitals (n=35) treated 5115 patients (27.7%), mean O/E=1.34±0.14 and median survival of 53.8months (95% CI=50.2-58.2months). After controlling for other variables, treatment at highest O/E hospitals was associated with independent and statistically significant improvement in ovarian cancer-specific survival compared to intermediate O/E (HR=1.06, 95% CI=1.01-1.11) and lowest O/E (1.16, 95% CI=1.10-1.23) hospitals. CONCLUSIONS Calculation of hospital-specific O/E for NCCN treatment guideline adherence, combined with minimum case volume criterion, as a measure of ovarian cancer quality of care is feasible and is an independent predictor of survival.
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Affiliation(s)
- Valerie B Galvan-Turner
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, United States
| | - Jenny Chang
- Department of Epidemiology, University of California Irvine, Irvine, CA, United States
| | - Argyrios Ziogas
- Department of Epidemiology, University of California Irvine, Irvine, CA, United States
| | - Robert E Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, CA, United States.
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18
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Cowan RA, O'Cearbhaill RE, Gardner GJ, Levine DA, Roche KL, Sonoda Y, Zivanovic O, Tew WP, Sala E, Lakhman Y, Vargas Alvarez HA, Sarasohn DM, Mironov S, Abu-Rustum NR, Chi DS. Is It Time to Centralize Ovarian Cancer Care in the United States? Ann Surg Oncol 2015; 23:989-93. [PMID: 26511267 DOI: 10.1245/s10434-015-4938-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this article was to broadly review the most up-to-date information pertaining to the centralization of ovarian cancer care in the United States (US) and worldwide. METHODS Much of the present literature pertaining to disparities in, and centralization of, ovarian cancer care in the US and internationally was reviewed, and specifically included original research and review articles. RESULTS Data show improved optimal debulking rates, National Comprehensive Cancer Network (NCCN) guideline adherence, and overall survival rates in higher-volume, more specialized hospitals, and amongst higher-volume providers. CONCLUSIONS Patients with invasive epithelial ovarian cancer, especially those with higher stages (III and IV), are better served by centralized care in high-volume hospitals and by high-volume physicians, who adhere to NCCN guidelines wherever possible. More research is needed to determine the policy changes that can increase NCCN guideline adherence in low-volume hospitals and low-provider caseload scenarios. Policy and future research should be aimed at increasing patient access, either directly or indirectly, to high-volume hospital and high-volume providers, especially amongst Medicare, lower socioeconomic status, and minority patients.
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Affiliation(s)
- Renee A Cowan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roisin E O'Cearbhaill
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Douglas A Levine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William P Tew
- Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Evis Sala
- Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hebert A Vargas Alvarez
- Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra M Sarasohn
- Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Svetlana Mironov
- Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Weill Cornell Medical College, New York, NY, USA.
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Weill Cornell Medical College, New York, NY, USA.
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Tsukada Y, Nakamura F, Iwamoto M, Nishimoto H, Emori Y, Terahara A, Higashi T. Are hospitals in Japan with larger patient volume treating younger and earlier-stage cancer patients? An analysis of hospital-based cancer registry data in Japan. Jpn J Clin Oncol 2015; 45:719-26. [PMID: 25979245 DOI: 10.1093/jjco/hyv069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/10/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Differences in hospital case-mix have not been adequately accounted for in hospital volume and patient outcome studies in Japan. We aimed to examine whether differences may exist by investigating the distribution of patients' stage and age across designated cancer treatment hospitals of varying patient volume across Japan. METHODS We analyzed data of gastric, breast, colorectal, lung and liver cancer patients who were included in the national database of hospital-based cancer registries between 2008 and 2011. We investigated the association between hospital volume, cancer stage and patient age. Hospitals were classified into five groups according to patient volume. RESULTS In total, 676 713 patients met the inclusion criteria. The proportion of patients with early-stage (tumor-node-metastasis Stage 0 or I) cancer was higher among high-volume hospitals for all cancer types except small cell lung cancer. The proportion of older patients (age >75 years) was smaller among high-volume hospitals for all cancer types. The difference in the proportion of patients with early-stage cancers between very low-volume and very high-volume hospitals was greatest for non-small cell lung cancer (26.5% for very low and 43.5% for very high). This difference for the proportion of older patients was also greatest for non-small cell lung cancer (48.9% for very low and 30.3% for very high). CONCLUSIONS We showed that the proportions of early-stage cancer patients and younger patients are greater in higher-volume hospitals compared with lower-volume hospitals in Japan. Researchers conducting volume-outcome studies and policymakers analyzing hospital performance should be cautious when making interhospital comparisons.
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Affiliation(s)
- Yoichiro Tsukada
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo Department of Radiology, Toho University Omori Medical Center, Tokyo
| | - Fumiaki Nakamura
- Department of Public Health/Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Momoko Iwamoto
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo
| | - Hiroshi Nishimoto
- Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Yoshiko Emori
- Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Atsuro Terahara
- Department of Radiology, Toho University Omori Medical Center, Tokyo
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo
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20
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Cliby WA, Powell MA, Al-Hammadi N, Chen L, Philip Miller J, Roland PY, Mutch DG, Bristow RE. Ovarian cancer in the United States: contemporary patterns of care associated with improved survival. Gynecol Oncol 2014; 136:11-7. [PMID: 25449311 DOI: 10.1016/j.ygyno.2014.10.023] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/17/2014] [Accepted: 10/23/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ovarian cancer (OC) requires complex multidisciplinary care with wide variations in outcome. We sought to determine the impact of institutional and process of care factors on overall survival (OS) and delivery of guideline care nationally. METHODS This was a retrospective cohort study of primary OC diagnosed from 1998 to 2007 using the National Cancer Data Base (NCDB) capturing 80% of all U.S. cases. Patient- (demographics, comorbidities, stage/grade), process of care (adherence to guidelines) and institutional- (facility type, case volume) factors were evaluated. Primary outcomes were OS and delivery of guideline therapy. Multivariable logistic regression and Cox proportional hazards models were used for analysis. RESULTS We analyzed 96,802 consecutive cases. Five-year OS was 84%, 66.3%, 32% and 15.7% for stages I, II, III and IV, respectively. The annual mean facility case volumes varied by cancer center type (range: 5.7 to 26.7), with 25% of cases spread over 65% of centers--all treating fewer than 8 cases. Overall, 56% of cases received non-guideline care. Low facility case volume and higher comorbidity index independently predicted non-guideline care; high volume centers were less likely to deliver non-guideline care (OR: 0.44, 95% CI: 0.41-0.47). Delivery of non-guideline care (OR: 1.4, 95% CI: 1.36-1.44), and higher facility case volume (OR: 0.91, 95% CI: 0.86-0.96) were both independent predictors of OS. CONCLUSIONS Delivery of guideline care and facility case volume are important drivers of overall survival. Most cancer centers treat very few women with OC. National efforts should focus on improved access to centers with expertise in OC and ensuring delivery of guideline care.
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Affiliation(s)
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, USA
| | - Noor Al-Hammadi
- Division of Biostatistics, Washington University School of Medicine, USA
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine, USA
| | - J Philip Miller
- Division of Biostatistics, Washington University School of Medicine, USA
| | - Phillip Y Roland
- Gynecologic Oncology, Department of Gynecology and Obstetrics, Saint Francis Hospital and Medical Center, USA
| | - David G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, USA
| | - Robert E Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, USA
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High-volume ovarian cancer care: survival impact and disparities in access for advanced-stage disease. Gynecol Oncol 2013; 132:403-10. [PMID: 24361578 DOI: 10.1016/j.ygyno.2013.12.017] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/06/2013] [Accepted: 12/13/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To characterize the impact of hospital and physician ovarian cancer case volume on survival for advanced-stage disease and investigate socio-demographic variables associated with access to high-volume providers. METHODS Consecutive patients with stage IIIC/IV epithelial ovarian cancer (1/1/96-12/31/06) were identified from the California Cancer Registry. Disease-specific survival analysis was performed using Cox-proportional hazards model. Multivariate logistic regression analyses were used to evaluate for differences in access to high-volume hospitals (HVH) (≥20 cases/year), high-volume physicians (HVP) (≥10 cases/year), and cross-tabulations of high- or low-volume hospital (LVH) and physician (LVP) according to socio-demographic variables. RESULTS A total of 11,865 patients were identified. The median ovarian cancer-specific survival for all patients was 28.2 months, and on multivariate analysis the HVH/HVP provider combination (HR = 1.00) was associated with superior ovarian cancer-specific survival compared to LVH/LVP (HR = 1.31, 95%CI = 1.16-1.49). Overall, 2119 patients (17.9%) were cared for at HVHs, and 1791 patients (15.1%) were treated by HVPs. Only 4.3% of patients received care from HVH/HVP, while 53.1% of patients were treated by LVH/LVP. Both race and socio-demographic characteristics were independently associated with an increased likelihood of being cared for by the LVH/LVP combination and included: Hispanic race (OR = 1.72, 95%CI = 1.22-2.42), Asian/Pacific Islander race (OR = 1.57, 95%CI = 1.07-2.32), Medicaid insurance (OR = 2.51, 95%CI = 1.46-4.30), and low socioeconomic status (OR = 2.84, 95%CI = 1.90-4.23). CONCLUSIONS Among patients with advanced-stage ovarian cancer, the provider combination of HVH/HVP is an independent predictor of improved disease-specific survival. Access to high-volume ovarian cancer providers is limited, and barriers are more pronounced for patients with low socioeconomic status, Medicaid insurance, and racial minorities.
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Nakamura K, Ohga S, Yorozu A, Dokiya T, Saito S, Yamanaka H. Diffusion pattern of low dose rate brachytherapy for prostate cancer in Japan. Cancer Sci 2013; 104:934-6. [PMID: 23560460 DOI: 10.1111/cas.12168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/01/2013] [Accepted: 04/02/2013] [Indexed: 11/30/2022] Open
Abstract
Permanent implant brachytherapy for prostate cancer using iodine-125 seeds was adopted in Japan in 2003. Here, we report on the diffusion pattern of this treatment in Japan since 2003. We examined the annual numbers of prostate cancer patients per hospital in Japan, who were treated with iodine-125 seed implant brachytherapy with or without external beam radiation therapy between 2003 and 2011. The hospitals were excluded from the count if brachytherapy was begun in a hospital within the given year, and thus was only available for part of the year. In 2004, 269 patients were treated by brachytherapy at only two hospitals. However, the numbers increased rapidly. A total of 1412 patients were treated at 23 hospitals in 2005, 2783 patients were treated at 83 hospitals in 2008, and 3793 patients were treated at 109 hospitals in 2011. The mean/median numbers of patients treated per hospital were 61.4/42 in 2005, 33.5/25 in 2008, and 35.0/24 in 2011. The number of hospitals where 24 or fewer patients were treated in a year increased. On the other hand, the number of hospitals with a volume of >48 patients per year was stable. Because a relationship between provider volume and outcomes following oncological procedures was shown, a careful evaluation of the effectiveness of permanent implant brachytherapy for prostate cancer is needed.
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Affiliation(s)
- Katsumasa Nakamura
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Murata A, Matsuda S, Kuwabara K, Ichimiya Y, Matsuda Y, Kubo T, Fujino Y, Fujimori K, Horiguchi H. Association between hospital volume and outcomes of elderly and non-elderly patients with acute biliary diseases: a national administrative database analysis. Geriatr Gerontol Int 2012; 13:731-40. [PMID: 22985177 DOI: 10.1111/j.1447-0594.2012.00938.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM This study aimed to investigate the relationship between hospital volume and clinical outcomes of elderly and non-elderly patients with acute biliary diseases using data from a national administrative database. METHODS Overall, 26720 elderly and 33774 non-elderly patients with acute biliary diseases were referred to 820 hospitals in Japan. Hospital volume was categorized into three groups based on the case numbers during the study period: low-volume, medium-volume and high-volume. We compared the risk-adjusted length of stay (LOS) and in-hospital mortality in relation to hospital volume. These analyses were stratified according to the presence of invasive treatments for acute biliary diseases. RESULTS Multiple linear regression analyses showed that increased hospital volume was significantly associated with shorter LOS in both elderly and non-elderly patients with and without invasive treatments. Increased hospital volume was significantly associated with decreased relative risk of in-hospital mortality in elderly patients. The odds ratio for high-volume hospitals was 0.672 in elderly patients without invasive treatments (95% confidence interval [CI] 0.533-0.847, P=0.001) and 0.715 in those with invasive treatments (95% C, 0.566-0.904, P=0.005). However, no significant differences for in-hospital mortality were seen in non-elderly patients with and without invasive treatments. CONCLUSION This study has highlighted that higher volume hospitals significantly reduced LOS and in-hospital mortality for elderly patients with acute biliary diseases, but not non-elderly patients. The current results are of value for elderly healthcare policy decision-making, and highlight the need for further studies into the quality of care for elderly patients.
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Affiliation(s)
- Atsuhiko Murata
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Reade C, Elit L. Trends in Gynecologic Cancer Care in North America. Obstet Gynecol Clin North Am 2012; 39:107-29. [DOI: 10.1016/j.ogc.2012.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Woo YL, Kyrgiou M, Bryant A, Everett T, Dickinson HO. Centralisation of services for gynaecological cancers - a Cochrane systematic review. Gynecol Oncol 2012; 126:286-90. [PMID: 22507534 DOI: 10.1016/j.ygyno.2012.04.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 04/07/2012] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Gynaecological cancers are the second most common cancers among women. It has been suggested that centralised care improves outcomes but consensus is lacking. This systematic review assesses the effectiveness of centralisation of care for patients with gynaecological cancer, in particular, survival advantage. METHODS A comprehensive search of the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL (The Cochrane Library, Issue 4, 2010), MEDLINE, and EMBASE up to November 2010 was conducted. Registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies were also searched. Randomised controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, interrupted time series studies, and observational studies were included and multivariable analysis to adjust for baseline case mix were used. RESULTS Five retrospective observational studies met the inclusion criteria. Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent. CONCLUSIONS The meta-analysis provides evidence to suggest that women with gynaecological cancer who received treatment in specialised centres had longer survival than those managed elsewhere.
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Affiliation(s)
- Yin Ling Woo
- Department of Obstetrics and Gynaecology, Affiliated with University Malaya Cancer Research Institute, Faculty of Medicine, University Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia.
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Abstract
BACKGROUND Gynaecological cancers are the second most common cancers among women. It has been suggested that centralised care improves outcomes but consensus is lacking. OBJECTIVES To assess the effectiveness of centralisation of care for patients with gynaecological cancer. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL (The Cochrane Library, Issue 4, 2010), MEDLINE, and EMBASE up to November 2010. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, controlled before-and-after studies, interrupted time series studies, and observational studies that examined centralisation of services for gynaecological cancer, and used multivariable analysis to adjust for baseline case mix. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data, and two assessed risk of bias. Where possible, we synthesised the data on survival in a meta-analysis. MAIN RESULTS Five studies met our inclusion criteria; all were retrospective observational studies and therefore at high risk of bias.Meta-analysis of three studies assessing over 9000 women suggested that institutions with gynaecologic oncologists on site may prolong survival in women with ovarian cancer, compared to community or general hospitals: hazard ratio (HR) of death was 0.90 (95% confidence interval (CI) 0.82 to 0.99). Similarly, another meta-analysis of three studies assessing over 50,000 women, found that teaching centres or regional cancer centres may prolong survival in women with any gynaecological cancer compared to community or general hospitals (HR 0.91; 95% CI 0.84 to 0.99). The largest of these studies included all gynaecological malignancies and assessed 48,981 women, so the findings extend beyond ovarian cancer. One study compared community hospitals with semi-specialised gynaecologists versus general hospitals and reported non-significantly better disease-specific survival in women with ovarian cancer (HR 0.89; 95% CI 0.78 to 1.01). The findings of included studies were highly consistent. Adverse event data were not reported in any of the studies. AUTHORS' CONCLUSIONS We found low quality, but consistent evidence to suggest that women with gynaecological cancer who received treatment in specialised centres had longer survival than those managed elsewhere. The evidence was stronger for ovarian cancer than for other gynaecological cancers.Further studies of survival are needed, with more robust designs than retrospective observational studies. Research should also assess the quality of life associated with centralisation of gynaecological cancer care. Most of the available evidence addresses ovarian cancer in developed countries; future studies should be extended to other gynaecological cancers within different healthcare systems.
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Affiliation(s)
- Yin Ling Woo
- Department of Obstetrics and Gynaecology, Affiliated to University of Malaya Cancer Research Institute, Kuala Lumpur, Malaysia.
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Fagö-Olsen CL, Høgdall C, Kehlet H, Christensen IJ, Ottesen B. Centralized treatment of advanced stages of ovarian cancer improves survival: a nationwide Danish survey. Acta Obstet Gynecol Scand 2010; 90:273-9. [PMID: 21306310 DOI: 10.1111/j.1600-0412.2010.01043.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This retrospective, nationwide, observational study was designed to compare treatment in tertiary referral centers vs. regional hospitals on overall survival for patients with stage IIIC and IV ovarian cancer. MATERIAL AND METHODS The study took place in all gynecological departments in Denmark, involving a total of 1,160 patients with stage IIIC or IV ovarian cancer. Data were extracted for 2,024 patients with all stages of ovarian cancer recorded in the Danish Gynecological Cancer Database between 1 January 2005 and 31 December 2008. The main outcome measure was overall survival. RESULTS No difference was found between tertiary centers and regional hospitals with regard to age, body mass index, American Society of Anesthesiologists score or comorbidity. Patients in regional hospitals had poorer Eastern Cooperative Oncology Group performance status, i.e.1.0 vs. 2.0 (p= 0.005). Patients in referral centers presented more often with stage IIIC and IV disease, i.e. 59.7 vs. 51.7% (p < 0.001). Patients with stage IIIC and IV disease in regional vs. tertiary hospitals had a higher rate of primary cytoreductive surgery, i.e. 89.5 vs. 82.5% (p= 0.004), a poorer rate of complete cytoreductive surgery following primary cytoreductive surgery, i.e. 13.9 vs. 25.2% (p < 0.001), a lower rate of neoadjuvant chemotherapy, i.e. 5.5 vs. 13.4% (p < 0.001), and more often underwent acute surgery, i.e. 17.0 vs. 9.2% (p < 0.001). Patients treated in referral centers had better overall survival (p= 0.021). Treatment in a referral center was an independent prognostic factor for overall survival hazard ratio, 0.83 (confidence interval 0.70-0.98). CONCLUSION Patients with stage IIIC and IV ovarian cancer benefit from treatment in a tertiary referral center.
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Wouters M, Jansen-Landheer M, van de Velde C. The quality of cancer care initiative in the Netherlands. Eur J Surg Oncol 2010; 36 Suppl 1:S3-S13. [DOI: 10.1016/j.ejso.2010.06.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 06/01/2010] [Indexed: 01/08/2023] Open
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Bristow RE, Palis BE, Chi DS, Cliby WA. The National Cancer Database report on advanced-stage epithelial ovarian cancer: Impact of hospital surgical case volume on overall survival and surgical treatment paradigm. Gynecol Oncol 2010; 118:262-7. [DOI: 10.1016/j.ygyno.2010.05.025] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 05/20/2010] [Accepted: 05/25/2010] [Indexed: 10/19/2022]
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Timmers P, Zwinderman A, Coens C, Vergote I, Trimbos J. Understanding the problem of inadequately staging early ovarian cancer. Eur J Cancer 2010; 46:880-4. [DOI: 10.1016/j.ejca.2009.12.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 11/29/2009] [Accepted: 12/03/2009] [Indexed: 11/25/2022]
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Kumpulainen S, Sankila R, Leminen A, Kuoppala T, Komulainen M, Puistola U, Hurme S, Hiekkanen H, Mäkinen J, Grénman S. The effect of hospital operative volume, residual tumor and first-line chemotherapy on survival of ovarian cancer — A prospective nation-wide study in Finland. Gynecol Oncol 2009; 115:199-203. [DOI: 10.1016/j.ygyno.2009.07.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 07/08/2009] [Accepted: 07/09/2009] [Indexed: 11/26/2022]
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Impact of surgeon and hospital ovarian cancer surgical case volume on in-hospital mortality and related short-term outcomes. Gynecol Oncol 2009; 115:334-8. [PMID: 19766295 DOI: 10.1016/j.ygyno.2009.08.025] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 08/28/2009] [Accepted: 08/29/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the impact of surgeon and hospital case volume, and other related variables, on short-term outcomes after surgery for ovarian cancer. METHODS The Maryland Health Service Cost Review Commission database was accessed for ovarian cancer surgical cases including both oophorectomy and any staging/cytoreductive surgical procedure from 2001 to 2008. Multivariate logistic regression analyses and multiple linear regression models were used to evaluate for significant associations between surgeon and hospital case volume, as well as other independent variables, and the risk of in-hospital death, extent of surgery, length of hospital stay, and hospital-related cost of care. RESULTS Overall, 1894 primary ovarian cancer operations were performed by 352 surgeons at 43 hospitals. After controlling for the effects of all variables, the only independently significant factors associated with the risk of in-hospital death were surgery by a high-volume surgeon and an APR-DRG mortality risk score of 4. Ovarian cancer surgery performed by a high-volume surgeon was associated with a 69% reduction in the risk of in-hospital death. Surgery at a high-volume hospital was an independent positive predictor of a cytoreductive procedure. A statistically significant negative correlation was observed between surgery at a high-volume hospital and both length of hospital stay and hospital-related cost. CONCLUSIONS After controlling for other factors, ovarian cancer surgery performed by a high-volume surgeon is associated with a 69% reduction in the risk of in-hospital death, while high-volume hospital care is associated with increased likelihood of cytoreduction, shorter length of stay, and lower hospital-related cost of care.
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Bristow RE, Puri I, Diaz-Montes TP, Giuntoli RL, Armstrong DK. Analysis of Contemporary Trends in Access to High-Volume Ovarian Cancer Surgical Care. Ann Surg Oncol 2009; 16:3422-30. [PMID: 19711131 DOI: 10.1245/s10434-009-0680-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 07/28/2009] [Indexed: 11/18/2022]
Affiliation(s)
- Robert E Bristow
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Yasunaga H, Nishii O, Hirai Y, Ochiai K, Matsuyama Y, Ohe K. Impact of surgeon and hospital volumes on short-term postoperative complications after radical hysterectomy for cervical cancer. J Obstet Gynaecol Res 2009; 35:699-705. [DOI: 10.1111/j.1447-0756.2009.01027.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ito Y, Ioka A, Tsukuma H, Ajiki W, Sugimoto T, Rachet B, Coleman MP. Regional differences in population-based cancer survival between six prefectures in Japan: application of relative survival models with funnel plots. Cancer Sci 2009; 100:1306-11. [PMID: 19432897 PMCID: PMC11158017 DOI: 10.1111/j.1349-7006.2009.01170.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 03/03/2009] [Accepted: 03/15/2009] [Indexed: 11/28/2022] Open
Abstract
We used new methods to examine differences in population-based cancer survival between six prefectures in Japan, after adjustment for age and stage at diagnosis. We applied regression models for relative survival to data from population-based cancer registries covering each prefecture for patients diagnosed with stomach, lung, or breast cancer during 1993-1996. Funnel plots were used to display the excess hazard ratio (EHR) for each prefecture, defined as the excess hazard of death from each cancer within 5 years of diagnosis relative to the mean excess hazard (in excess of national background mortality by age and sex) in all six prefectures combined. The contribution of age and stage to the EHR in each prefecture was assessed from differences in deviance-based R(2) between the various models. No significant differences were seen between prefectures in 5-year survival from breast cancer. For cancers of the stomach and lung, EHR in Osaka prefecture were above the upper 95% control limits. For stomach cancer, the age- and stage-adjusted EHR in Osaka were 1.29 for men and 1.43 for women, compared with Fukui and Yamagata. Differences in the stage at diagnosis of stomach cancer appeared to explain most of this excess hazard (61.3% for men, 56.8% for women), whereas differences in age at diagnosis explained very little (0.8%, 1.3%). This approach offers the potential to quantify the impact of differences in stage at diagnosis on time trends and regional differences in cancer survival. It underlines the utility of population-based cancer registries for improving cancer control.
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Affiliation(s)
- Yuri Ito
- Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
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Le T, Giede C, Salem S, Le T, Lefebvre G, Rosen B, Bentley J, Giede C, Kupets R, Power P, Renaud MC, Bryson P, Davis DB, Lau S, Lotocki R, Senikas V, Morin L, Bly S, Butt K, Cargill YM, Denis N, Gagnon R, Hietala-Coyle MA, Lim KI, Ouellet A, Racicot MH, Salem S. Prise en charge des masses pelviennes/ovariennes : Évaluation initiale et lignes directrices quant à l’orientation des patientes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009. [DOI: 10.1016/s1701-2163(16)34255-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Initial Evaluation and Referral Guidelines for Management of Pelvic/Ovarian Masses. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:668-80. [DOI: 10.1016/s1701-2163(16)34254-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Marth C, Hiebl S, Oberaigner W, Winter R, Leodolter S, Sevelda P. Influence of Department Volume on Survival for Ovarian Cancer: Results From a Prospective Quality Assurance Program of the Austrian Association for Gynecologic Oncology. Int J Gynecol Cancer 2009; 19:94-102. [DOI: 10.1111/igc.0b013e31819915cb] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective:The Austrian Association for Gynecologic Oncology initiated in 1998 a prospective quality assurance program for patients with ovarian cancer. The aim of this study was to evaluate factors predicting overall survival especially under consideration of department volume.Methods:All Austrian gynecological departments were invited to participate in the quality assurance program. A questionnaire was sent out that included birth date, histology, date of diagnosis, stage, and basic information on primary treatment. Description of comorbidity was not requested. Patient life status was assessed in a passive way. We did record linkage between each patient's name and birth date and the official mortality data set collected by Statistics Austria. No data were available on progression-free survival. Patients treated between January 1, 1999 and December 31, 2004 were included in the analysis. Mortality dates were available to December 31, 2006. Data were analyzed by means of classical statistical methods. Cut-off point for departments was 24 patients per year.Results:A total of 1948 patients were evaluable. Approximately 75% of them were treated at institutions with fewer than 24 new patients per year. Patient characteristics were grossly similar for both department types. Multivariate analysis confirmed established prognostic factors such as International Federation of Gynecologists and Obstetricians (FIGO) stage, lymphadenectomy, age, grading, and residual disease. In addition, we found small departments (<24 patients per year) to have a negative effect on overall survival (hazards ratio, 1.38: 95% confidence interval, 1.2-1.7; and P < 0.001).Conclusions:The results indicate that in Austria, rules prescribing minimum department case load can further improve survival for patients with ovarian cancer.
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du Bois A, Rochon J, Pfisterer J, Hoskins WJ. Variations in institutional infrastructure, physician specialization and experience, and outcome in ovarian cancer: a systematic review. Gynecol Oncol 2008; 112:422-36. [PMID: 18990435 DOI: 10.1016/j.ygyno.2008.09.036] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 09/24/2008] [Accepted: 09/29/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ovarian cancer outcome varies among different institutions, regions, and countries. This systematic review summarizes the available data evaluating the impact of different physician and hospital characteristics on outcome in ovarian cancer patients. METHODS A MEDLINE database search for pertinent publications was conducted and reference lists of each relevant article were screened. Experts in the field were contacted. Selected studies assessed the relationship between physician and/or hospital specialty or volume and at least one of the outcomes of interest. The primary outcome was survival. Additional parameters included surgical outcome (debulking), completeness of staging, and quality of chemotherapy. The authors independently reviewed each article and applied the inclusion/exclusion criteria. The quality of each study was assessed by focusing on strategies to control for important prognostic factors. RESULTS Forty-four articles met inclusion criteria. Discipline and sub-specialization of the primary treating physician were identified as the most important variable associated with superior outcome. Evidence showing a beneficial impact of institutional factors was weaker, but followed the same trend. Hospital volume was hardly related to any outcome parameter. CONCLUSIONS The limited evidence available showed considerable heterogeneity and has to be interpreted cautiously. Better utilization of knowledge about institutional factors and well-established board certifications may improve outcome in ovarian cancer. Patients and primary-care physicians should select gynecologic oncologists for primary treatment in countries with established sub-specialty training. Policymakers, insurance companies, and lay organizations should support development of respective programs.
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Affiliation(s)
- Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Dr. Horst Schmidt Klinik (HSK), Ludwig-Erhard-Str. 100, D-65199 Wiesbaden, Germany.
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Miyata H, Motomura N, Ueda Y, Matsuda H, Takamoto S. Effect of procedural volume on outcome of coronary artery bypass graft surgery in Japan: Implication toward public reporting and minimal volume standards. J Thorac Cardiovasc Surg 2008; 135:1306-12. [DOI: 10.1016/j.jtcvs.2007.10.079] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 10/21/2007] [Accepted: 10/26/2007] [Indexed: 10/22/2022]
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Bristow RE, Santillan A, Diaz-Montes TP, Gardner GJ, Giuntoli RL, Meisner BC, Frick KD, Armstrong DK. Centralization of care for patients with advanced-stage ovarian cancer: a cost-effectiveness analysis. Cancer 2007; 109:1513-22. [PMID: 17354232 DOI: 10.1002/cncr.22561] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the cost-effectiveness of centralized referral of patients with advanced-stage epithelial ovarian cancer who underwent primary cytoreductive surgery and adjuvant chemotherapy. METHODS A decision-analysis model was used to compare 2 referral strategies for patients with advanced-stage ovarian cancer: 1) referral to an expert center, with a rate of optimal primary cytoreduction of 75% and utilization of combined intraperitoneal and intravenous adjuvant chemotherapy, and 2) referral to a less experienced center, with a rate of optimal primary cytoreduction of 25% and adjuvant treatment that consisted predominantly of intravenous chemotherapy alone. The cost-effectiveness of each strategy was evaluated from the perspective of society. RESULTS A cost-effectiveness analysis revealed that the strategy of expert center referral had an overall cost per patient of $50,652 and had an effectiveness of 5.12 quality-adjusted life years (QALYs). The strategy of referral to a less experienced center carried an overall cost of $39,957 and had an effectiveness of 2.33 QALYs. The expert center strategy was associated with an additional 2.78 QALYs at an incremental cost of $10,695 but was more cost-effective, with a cost-effective ratio of $9893 per QALY compared with $17,149 per QALY for the less experienced center referral strategy. Sensitivity analyses and a Monte Carlo simulation confirmed the robustness of the model. CONCLUSIONS According to results from the decision-analysis model, centralized referral of patients with ovarian cancer to an expert center was a cost-effective healthcare strategy and represents a paradigm for quality cancer care, delivering superior patient outcomes at an economically affordable cost. Increased efforts to align current patterns of care with a universal strategy of centralized expert referral are warranted.
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Affiliation(s)
- Robert E Bristow
- The Kelly Gynecologic Oncology Service, Department of Obstetrics and Gynecology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
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Oberaigner W, Stühlinger W. Influence of department volume on cancer survival for gynaecological cancers—A population-based study in Tyrol, Austria. Gynecol Oncol 2006; 103:527-34. [PMID: 16730055 DOI: 10.1016/j.ygyno.2006.03.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 03/17/2006] [Accepted: 03/28/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to assess the effect of department volume on survival of patients with gynaecological cancer. METHODS We conducted an observational population-based study in Tyrol, Austria. The analysis includes all patient data on incident gynaecological cancer collected by the Cancer Registry of Tyrol. Data were collected since 1988 on a population-based perspective; publication of incidence data since 1988 in Cancer Incidence in Five Continents gives evidence for good completeness and validity of the database. Patient survival status is assessed in a passive way by probabilistic record linkage between incidence data and official mortality data. We applied a multivariate Cox regression with variables age, sex, stage, year of diagnosis, histological verification of diagnosis, transfer to other hospital and department volume. Department volume was categorised in < or = 11/12-23/24-35/ > or = 36 patients per year reflecting one/two/three/more than three patients per month; categories were computed separately for every site we analysed. Departments with up to 11 patients per year were called small departments. RESULTS For 4,191 breast cancer patients, we found a negative effect for small departments; hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.22, 1.58. For ovarian cancer patients, we also found a negative effect for small departments (HR 1.27, 95% CI 1.05, 1.54). For cervical cancer patients, we found a positive effect for small departments (HR 0.67, 95% CI 0.51, 0.88). No effect was shown for corpus cancer (HR 0.80, 95% CI 0.63, 1.01). CONCLUSION The results indicate that, in our country, rules on minimum department case-load can further improve survival for breast and ovarian cancer patients.
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Affiliation(s)
- Willi Oberaigner
- Cancer Registry of Tyrol, Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd, Innsbruck, Austria.
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Nomura E, Tsukuma H, Ajiki W, Ishikawa O, Oshima A. Population-based study of the relationship between hospital surgical volume and 10-year survival of breast cancer patients in Osaka, Japan. Cancer Sci 2006; 97:618-22. [PMID: 16827802 PMCID: PMC11160065 DOI: 10.1111/j.1349-7006.2006.00215.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Breast cancer is the most prevalent cancer among Japanese women; however, its outcome has never been analyzed in relation to hospital volume in Japan. We utilized data from the Osaka Cancer Registry for investigating correlations between hospital volume and 10-year survival of breast cancer patients. According to the total number of surgical procedures of breast cancer in each hospital during the period 1985-1991, we classified reporting hospitals in Osaka into four categories (high, medium, low, very low). The survival analysis was restricted to the 4333 female patients reported who were 30-64 years old, living in Osaka Prefecture (except for Osaka City), and for whom active follow up was available more than 10 years after diagnosis. In total, the relative 10-year survival was 79.7% in the high-volume, 80.3% in the medium-volume, 78.2% in the low-volume, and 68.2% in the very low-volume hospitals. After adjustment for age at diagnosis, clinical stage and clues for detection with the Cox regression model, the patients who received care in the very low-volume hospitals had a significantly higher risk of death than those in the high-volume hospitals. Meanwhile, no significant differences in risk were observed for the other two categories. These findings led us to conclude that the surgical volume of the hospitals did not affect the 10-year survival rate significantly, except for the very low-volume hospitals in Osaka, Japan. However, the study of these relationships should be continued and expanded in future to include quality of life.
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Affiliation(s)
- Etsuko Nomura
- Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
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Canis M, Jardon K, Rabischong B, Bourdel N, Mage G. [Advanced ovarian cancer, an optimal surgical treatment is possible to all patients owing to laparoscopy]. ACTA ACUST UNITED AC 2006; 131:423-5. [PMID: 16949028 DOI: 10.1016/j.anchir.2006.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schrag D, Earle C, Xu F, Panageas KS, Yabroff KR, Bristow RE, Trimble EL, Warren JL. Associations between hospital and surgeon procedure volumes and patient outcomes after ovarian cancer resection. J Natl Cancer Inst 2006; 98:163-71. [PMID: 16449676 DOI: 10.1093/jnci/djj018] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Strong associations between provider (i.e., hospital or surgeon) procedure volumes and patient outcomes have been demonstrated for many types of cancer operation. We performed a population-based cohort study to examine these associations for ovarian cancer resections. METHODS We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to identify 2952 patients aged 65 years or older who had surgery for a primary ovarian cancer diagnosed from 1992 through 1999. Hospital- and surgeon-specific procedure volumes were ascertained based on the number of claims submitted during the 8-year study period. Primary outcome measures were mortality at 60 days and 2 years after surgery, and overall survival. Length of hospital stay was also examined. Patient age at diagnosis, race, marital status, comorbid illness, cancer stage, and median income and population density in the area of residence were used to adjust for differences in case mix. All P values are two-sided. RESULTS Neither hospital- nor surgeon-specific procedure volume was statistically significantly associated with 60-day mortality following primary ovarian cancer resection. However, differences by hospital volume were seen with 2-year mortality; patients treated at the low-, intermediate-, and high-volume hospitals had 2-year mortality rates of 45.2% (95% confidence interval [CI] = 42.1% to 48.4%), 41.1% (95% CI = 38.1% to 44.3%), and 40.4% (95% CI = 37.4% to 43.4%), respectively. The inverse association between hospital procedure volume and 2-year mortality was statistically significant both before (P = .011) and after (P = .006) case-mix adjustment but not after adjustment for surgeon volume. Two-year mortality for patients treated by low-, intermediate-, and high-volume surgeons was 43.2% (95% CI = 40.7% to 45.8%), 42.9% (95% CI = 39.5% to 46.4%), and 39.5% (95% CI = 36.0% to 43.2%), respectively; there was no association between 2-year mortality and surgeon procedure volume, with or without case-mix adjustment. After case-mix adjustment, neither hospital volume (P = .031) nor surgeon volume (P = .062) was strongly associated with overall survival. CONCLUSION Hospital- and surgeon-specific procedure volumes are not strong predictors of survival outcomes following surgery for ovarian cancer among women aged 65 years or older.
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Affiliation(s)
- Deborah Schrag
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Ioka A, Tsukuma H, Ajiki W, Oshima A. Influence of hospital procedure volume on uterine cancer survival in Osaka, Japan. Cancer Sci 2005; 96:689-94. [PMID: 16232201 PMCID: PMC11159615 DOI: 10.1111/j.1349-7006.2005.00094.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Recent publications suggest that the relationships between hospital procedure volume and cancer survival may be different according to characteristics of the cancer such as primary site, extent of disease, and the year of diagnosis. The associations between hospital procedure volume and survival for uterine cancer, however, have never been studied in Japan. Data from the Osaka Cancer Registry were used to investigate this issue. Hospitals were ranked according to the number of operations for uterine cancer performed per year (high, medium, low, very low) in a diagnosis year period (1975-1981, 1982-1989 and 1990-1997). Survival analysis was carried out for the reported 7213 patients who lived in Osaka Prefecture (excluding Osaka City) diagnosed in 1975-1997, or patients who lived in Osaka City diagnosed in 1993-1997, because active follow-up data on vital status 5 years after diagnosis were available. The relative 5-year survival was higher with increased hospital procedure volume after 1982 (49.8, 68.6, 70.9, and 75.9%, respectively, in 1982-1989; 45.7, 62.7, 71.4, and 77.6%, respectively, in 1990-1997), and only survival in high-volume hospitals increased in the period 1975-1997. After adjustment for age, subsite, extent of disease and surgery by using the Cox regression model, patients receiving care in very low, low, or medium-volume hospitals were found to have a higher risk of death than patients receiving care in high-volume hospitals. Similar findings were obtained when the analysis was conducted separately for patients with cancer of the cervix and those with cancer of the corpus uteri. Although some limitations exist in this study, our results suggest that uterine cancer survival might be superior in high-volume hospitals in Osaka, Japan.
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Affiliation(s)
- Akiko Ioka
- Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
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Giede KC, Kieser K, Dodge J, Rosen B. Who should operate on patients with ovarian cancer? An evidence-based review. Gynecol Oncol 2005; 99:447-61. [PMID: 16126262 DOI: 10.1016/j.ygyno.2005.07.008] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2005] [Revised: 07/16/2005] [Accepted: 07/18/2005] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the relationship between surgical specialty and survival in patients receiving initial surgical management for ovarian epithelial cancer. STUDY METHODS An analytic framework was constructed to address the principle question 'does the type of surgeon operating on patients with newly diagnosed ovarian epithelial cancer influence survival?' A literature search addressing the components of this analytic framework was carried out using the Cochrane Library, Medline, EMBASE, and HealthSTAR databases. Relevant articles were selected and graded using U.S. Preventive Services Task Force and Canadian Task Force guidelines. Results were summarized by quality as well as level of evidence. RESULTS Eighteen studies were reviewed. The quality of evidence was good in 3, fair in 8, and poor in 7 of the studies. The most common study flaws encountered were 'failure to account for confounders' and 'incompleteness of data'. In studies focusing on advanced disease, there was good quality evidence to support a 6- to 9-month median survival benefit for patients operated on by gynecologic oncologists rather than general gynecologists and/or general surgeons (P values 0.009 to 0.01). Studies focusing on early stage disease found gynecologic oncologists more likely to carry out optimal staging (P values 0.001 to 0.01). Increased survival could be explained by improved identification of true stage I patients. CONCLUSION Patients receiving initial surgical management for ovarian epithelial cancer should be operated on by gynecologic oncologists.
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