Does high surgeon and hospital surgical volume raise the five-year survival rate for breast cancer? A population-based study

Abstract

This study sets out to examine the relationship between both surgeon and hospital volume and five-year survival rates for breast cancer patients. We performed Cox proportional hazard regressions on a pooled population-based database linking the Taiwan National Health Insurance Research Database with the 'cause of death' data file, covering the three-year period from January 1997 to December 1999. Of the 13,360 breast cancer resection patients in our study sample, the five-year survival rates, by surgeon volume, were 77.3% in the high-volume group (>201 cases), 76.9% in the medium-volume group (45-200), and 69.5% in the low-volume group (<or=44). The five-year survival rates, by hospital volume, were 77.3% for high-volume hospitals (>585 cases), 74.5% for medium-volume hospitals (259-585) and 72.1% for low-volume hospitals (<or=258). Cox regression analyses show that the risk of death for patients treated by low-volume surgeons was up to 1.305 times (P < 0.001) as high as the risk for those treated by high-volume surgeons. Similarly, the risk of death for patients whose resections had been performed in low-volume hospitals was 1.484 times (P < 0.001) as high as the risk for those whose resections had been performed in high-volume hospitals. High surgeon or hospital volume contributes significantly to patient outcomes and may be regarded as an overall indicator of high treatment quality; we therefore strongly recommend that the healthcare authorities reveal to the public all of the relevant information on provider performance and caseloads in order to assist them to make the optimum choice when surgery becomes necessary.

Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status

“…53 The association between higher surgeon case load and higher survival found both in the unadjusted analysis and the analysis adjusted for age and clinical risk factors, accords with results of most studies in North America, Europe, Asia and Western Australia. 16,[28][29][30][31][32][33][34][35][36][37][38][39][40] The difference mostly occurred between 21-100 cases per annum and lower case loads, with little difference observed between the 21-100 and higher case loads. Other studies have shown a progressive association between higher case loads and survival, interpreted by some researchers as strengthening evidence of a causal relationship.…”

“…This was similar to classifications in some other studies, although classification categories have not been consistent across studies. [28][29][30][31][32][33][34][35][36][37][38][39][40][41] Treatment centre location was categorised as major city, inner regional or more remote, using the Australian Standard Geographical Classification. 44 These categories are based on Census Collection Districts (CDs) categorised using the Accessibility/Remoteness Index for Australia (ARIA), which is a measure of the remoteness of a location from the services provided by large towns or cities.…”

“…16,[19][20][21][22][23][24][25][26][27] Often these were studies of other cancers, although higher survivals from breast cancer have been linked to higher case loads in North America, Europe, Asia and Western Australia. [28][29][30][31][32][33][34][35][36][37][38][39][40] Results have generally been interpreted as reflecting higher skill development from managing higher case loads, although this interpretation has been questioned and alternative explanations suggested, including accompanying differences in degree of specialisation, access to multidisciplinary conferencing, and availability of specialist adjunctive services. 22,33,41 In the USA, lack of private health insurance can be a barrier to appropriate breast and other cancer care for optimising survival.…”

Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: A nationwide population‐based study

“…A growing body of studies has reported that high provider volume, especially surgeon volume, 14,16,19,22 significantly reduces complications and improves the outcomes of patients with cancer. 10,13,23 Lin et al reported a dose-response relation in that high-volume hospitals had lower in-hospital mortality after performance of cancerrelated colectomy. 7 Cornish et al reported that the organizational structure of the hospital impacted the hospital length of stay and 30-day risk-adjusted mortality, as did a harvest of 12 lymph nodes and circumferential margin involvement, which were found to be related to long-term outcomes.…”

“…In addition, hospitals with a larger volume may be more likely to adhere to guidelines, 11 adopt multidisciplinary approaches, 12 and provide high-quality treatment. 13 Taiwan's National Health Insurance (NHI) program is a single-payer, mandatory universal social insurance that provides comprehensive coverage to all Taiwan's residents. Its comprehensive coverage of cancer care with no or very limited cost-sharing substantially reduces the financial burdens of patients with CRC.…”