Clinical Outcomes Following Regionalization of Gastric Cancer Care in a US Integrated Health Care System

Uong, Stephen P; Lin, Teresa; Shiraga, Sharon; Li, Yan; Gong, I-Yeh; Herrinton, Lisa J.; Li, Robert A.

doi:10.1200/jco.21.00480

Cited by 18 publications

(14 citation statements)

References 29 publications

(48 reference statements)

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“…As a result, “step-down treatment” was recommended as a sensible medication approach for antimicrobial drug usage in ICU patients with severe bacterial infections. A step-down regimen used in the clinical treatment of elderly patients with severe pneumonia in the ICU has been proven to be highly effective, improving all blood gas indicators and decreasing the period of symptom alleviation and hospitalization [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Step-Down Therapy versus Conventional Antimicrobial Therapy in the Treatment of Patients with Sepsis

et al. 2022

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Objective. This study was to evaluate the efficacy of antimicrobial step-down therapy versus conventional antimicrobial therapy in the treatment of patients with sepsis. Methods. Between September 2020 and September 2021, 65 patients with sepsis treated in the intensive care unit (ICU) of our hospital were recruited and assigned at a ratio of 1 : 1 to receive either conventional antimicrobial therapy (sulbactam plus cefoperazone) (control group) or antimicrobial step-down therapy (imipenem/cilastatin) (observation group). The results of drug sensitivity tests and clinical effects were evaluated comprehensively after 3-5 d of treatment, downgraded, and upgraded, or maintenance treatment was administered for 10 d. Outcome measures included clinical and laboratory indices and treatment efficacy. Results. Antimicrobial step-down therapy resulted in a significantly higher efficacy and lower levels of white blood cell (WBC) count and C-reactive protein (CRP) versus conventional antimicrobial therapy ( P < 0.05 ). The patients given antimicrobial step-down therapy showed a significantly shorter duration of antimicrobial drug administration, temperature recovery, time of respiratory support, and ICU stays versus conventional antimicrobial therapy ( P < 0.05 ). Conclusion. Antimicrobial step-down therapy contributes to the mitigation of inflammatory responses in patients with sepsis and shortens the duration of antimicrobial drug use and ICU stay versus conventional antimicrobial therapy. The reliability of the conclusions can be further increased if multicenter and large sample clinical observations can be conducted, which is the direction of endeavor for future clinical studies.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial Step-Down Therapy versus Conventional Antimicrobial Therapy in the Treatment of Patients with Sepsis

et al. 2022

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“…[29][30][31] Other groups have shown a similar relationship between hospital volume for gastric cancer and survival outcomes 24,28,32 and demonstrated an association between the regionalization of gastric cancer care and better patient outcomes in the United States. 33 In our study, the majority (52%, n = 19 496) of patients received treatment at a high-volume center. Highest-volume hospitals were nearly 2.5 times more likely to provide guideline-adherent care and care at highest-volume hospitals…”

Section: Resultsmentioning

confidence: 79%

“…The volume–outcome relationship has been well‐established in many domains of cancer care and in gastric cancer specifically, 24–28 but many other factors impact patient outcomes 29–31 . Other groups have shown a similar relationship between hospital volume for gastric cancer and survival outcomes 24,28,32 and demonstrated an association between the regionalization of gastric cancer care and better patient outcomes in the United States 33 . In our study, the majority (52%, n = 19 496) of patients received treatment at a high‐volume center.…”

Section: Discussionmentioning

confidence: 96%

Adherence to guidelines at the patient‐ and hospital‐levels is associated with improved overall survival in patients with gastric cancer

Kaslow

Hani

et al. 2022

Journal of Surgical Oncology

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Background and Objectives Adherence to evidence‐based guidelines in gastric cancer is low. We aimed to evaluate adherence to National Comprehensive Cancer Network (NCCN) Guidelines for gastric cancer at both patient‐ and hospital‐levels and examine associations between guideline adherence and treatment outcomes, including overall survival (OS). Methods We applied stage‐specific, annual NCCN Guidelines (2004–2015) to patients with gastric cancer treated with curative‐intent within the National Cancer Database and compared characteristics of patients who did and did not receive guideline‐adherent care. Hospitals were evaluated by guideline adherence rate. We identified associations with OS through multivariable Cox regression. Results Of 37 659 patients included, 32% received NCCN Guideline‐adherent treatment. OS was significantly associated with both guideline adherence (51 months for patients receiving guideline‐adherent treatment vs. 22 for patients receiving nonadherent treatment, p < 0.001). Treatment at a hospital with higher adherence was associated with longer OS (21 months for patients treated at lowest adherence quartile hospitals vs. 37 months at highest adherence quartile hospitals, p < 0.001), regardless of type of treatment received. Conclusions Guideline‐adherent treatment was strongly associated with longer median OS. Guideline adherence should be used as a benchmark for focused quality improvement for physicians taking care of patients with gastric cancer and institutions at large.

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“…27 Hospitals with lower case volumes may be unwilling or unable to make the investments needed to provide optimal care. 28 Breast surgery has a low postoperative mortality rate, so surgical volume is likely a surrogate for enhanced multidisciplinary expertise (such as medical or radiation oncologists) and/or resources such as patient navigation or social workers to facilitate higher-quality care.…”

Section: Discussionmentioning

confidence: 99%

Centralization of Initial Care and Improved Survival of Poor Patients With Breast Cancer

Nattinger

Bickell

Schymura

et al. 2023

JCO

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PURPOSE Poor women with breast cancer have worse survival than others, and are more likely to undergo surgery in low-volume facilities. We leveraged a natural experiment to study the effectiveness of a policy intervention undertaken by New York (NY) state in 2009 that precluded payment for breast cancer surgery for NY Medicaid beneficiaries treated in facilities performing fewer than 30 breast cancer surgeries annually. METHODS We identified 37,822 women with stage I-III breast cancer during 2004-2008 or 2010-2013 and linked them to NY hospital discharge data. A multivariable difference-in-differences approach compared mortality of Medicaid insured patients with that of commercially or otherwise insured patients unaffected by the policy. RESULTS Women treated during the postpolicy years had slightly lower 5-year overall mortality than those treated prepolicy; the survival gain was significantly larger for Medicaid patients ( P = .018). Women enrolled in Medicaid had a greater reduction than others in breast cancer–specific mortality ( P = .005), but no greater reduction in other causes of death ( P = .50). Adjusted breast cancer mortality among women covered by Medicaid declined from 6.6% to 4.5% postpolicy, while breast cancer mortality among other women fell from 3.9% to 3.8%. A similar effect was not observed among New Jersey Medicaid patients with breast cancer treated during the same years. CONCLUSION A statewide centralization policy discouraging initial care for breast cancer in low-volume facilities was associated with better survival for the Medicaid population targeted. Given these impressive results and those from prior research, other policymakers should consider adopting comparable policies to improve breast cancer outcomes.

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Clinical Outcomes Following Regionalization of Gastric Cancer Care in a US Integrated Health Care System

Cited by 18 publications

References 29 publications

Antimicrobial Step-Down Therapy versus Conventional Antimicrobial Therapy in the Treatment of Patients with Sepsis

Antimicrobial Step-Down Therapy versus Conventional Antimicrobial Therapy in the Treatment of Patients with Sepsis

Adherence to guidelines at the patient‐ and hospital‐levels is associated with improved overall survival in patients with gastric cancer

Centralization of Initial Care and Improved Survival of Poor Patients With Breast Cancer

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