Centralized primary care of advanced ovarian cancer improves complete cytoreduction and survival - A population-based cohort study

Dahm‐Kähler, Pernilla; Palmqvist, Charlotte; Staf, Christian; Holmberg, Erik; Johannesson, Liza

doi:10.1016/j.ygyno.2016.05.025

Cited by 75 publications

(60 citation statements)

References 30 publications

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“…11,12,27–30 For some procedures, this appears to be a reasonable strategy. After national efforts to concentrate some surgical procedures to high-volume hospitals, Finks and colleagues reported that from 1999–2008 the number of hospitals performing four high-risk cancer operations decreased, while the median volume of those hospitals performing the procedures increased.…”

Section: Discussionmentioning

confidence: 99%

Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer

Wright

Chen

Hou

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To assess whether strict adherence to quality metrics by hospitals could explain the association between hospital volume and survival for ovarian cancer. Methods We used the National Cancer Data Base to perform a retrospective cohort study of women with ovarian cancer from 2004 to 2013. Hospitals were stratified by annual case volume into quintiles (≤2, 2.01–5, 5.01–9, 9.01–19.9, ≥20 cases) and by adherence to ovarian cancer quality metrics into quartiles. Hospital-level adjusted 2- and 5-year survivals were compared based on volume and adherence to the quality metrics. Results A total of 100,725 patients at 1268 hospitals were identified. Higher-volume hospitals were more likely to adhere to the quality metrics. Both 2- and 5-year survival increased with hospital volume and with adherence to the measured quality metrics. For example, 2-year survival increased from 64.4% (95% CI, 62.5–66.4%) at low volume to 77.4% (95% CI, 77.0–77.8%) at high-volume centers and from 66.5% (65.5–67.5%) at low-quality to 77.3% (95% CI, 76.8–77.7%) at high-quality hospitals (P<0.001 for both). For each hospital volume category, survival increased with increasing adherence to the quality metrics. For example, in the lowest-volume hospitals (≤2 cases annually), adjusted 2-year survival was 61.4% (95% CI, 58.4–64.5%) at hospital with the lowest adherence to quality metrics and rose to 65.8% (95% CI, 61.2–70.8%) at the hospitals with highest adherence to the quality metrics (P<0.001). However, lower-volume hospitals with higher-quality scores still had survival that was lower than higher-volume hospitals. Conclusion While both hospital volume and adherence to quality metrics are associated with survival for ovarian cancer, low-volume hospitals that provide high-quality care still have survival rates that are lower than high-volume centers.

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Section: Discussionmentioning

confidence: 99%

Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer

Wright

Chen

Hou

et al. 2017

Obstetrics &Amp; Gynecology

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“…A centralized cancer care model has been implemented in smaller countries with more homogeneously spread out population centers [32]. In the US, specialized centers have been award NCI designation as when a critical mass of cancer related expertise is available.…”

Section: Discussionmentioning

confidence: 99%

Trends and factors associated with radical cytoreductive surgery in the United States: A case for centralized care

Sinno

Thompson

et al. 2017

Gynecologic Oncology

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Objectives To describe the US national trends and factors associated with cytoreductive surgical radicality in women with advanced ovarian cancer (OC). Methods An analysis of the National Inpatient Sample database was performed. All admissions from 1993 to 2011 for advanced OC cytoreductive surgery (CRS) were identified and categorized as simple pelvic (SP), extensive pelvic (EP), and extensive upper abdominal (EUA) surgery. Annual trends in CRS were analyzed. Associations between patient- and hospital-specific factors, with CRS radicality as well as perioperative complications were explored between 2007 and 2011. Results In total, 28,677 un-weighted admissions were analyzed. The rate of EP and EUA resections increased over time (8% to 18.1% and 1.3% to 5.4%, P < 0.01, respectively). On multivariate analysis, patients were more likely to undergo EUA resections in the Northeast (OR 1.44) or West Coast (OR 1.47) at urban (OR 2.3), or large hospitals (OR 1.4), or if they had private insurance (OR 1.45). EUA surgeries were performed more frequently at high-volume ovarian cancer centers (OR 2.65); additionally, fewer complications were observed after EUA at high compared with low and medium volume hospitals (10.2%, 21.2%, and 21.7%, respectively; P = 0.01). Specifically, patients treated at high volume hospitals experienced lower rates of hemorrhage, vascular/nerve injury, prolonged hospitalization, and non-routine discharge than at lower (P < 0.05). Conclusions The US rate of radical cytoreductive surgery for advanced ovarian cancer is increasing. At high-volume hospitals, patients receive more radical surgery with fewer complications, supporting further study of a centralized ovarian cancer care model.

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“…Epithelial ovarian cancer typically presents in an advanced stage and has the highest mortality rate of all gynaecological cancers in developed countries . There is evidence that optimal outcomes are achieved when patients are managed by trained gynaecological oncologists, in large‐volume centres, as part of a multidisciplinary team . The standard of care for many years has been primary debulking surgery (PDS) followed by adjuvant chemotherapy (AC), but over the last decade, there has been increasing interest in the role of neo‐adjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) followed by AC.…”

Section: Introductionmentioning

confidence: 99%

The shift toward neo‐adjuvant chemotherapy and interval debulking surgery for management of advanced ovarian and related cancers in a population‐based setting: Impact on clinical outcomes

Nicklin

McGrath

Tripcony

et al. 2017

Aust NZ J Obst Gynaeco

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Centralized primary care of advanced ovarian cancer improves complete cytoreduction and survival - A population-based cohort study

Cited by 75 publications

References 30 publications

Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer

Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer

Trends and factors associated with radical cytoreductive surgery in the United States: A case for centralized care

The shift toward neo‐adjuvant chemotherapy and interval debulking surgery for management of advanced ovarian and related cancers in a population‐based setting: Impact on clinical outcomes

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