Ovarian cancer in the United States: Contemporary patterns of care associated with improved survival

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.

What Underlies the Observed Hospital Volume-Outcome Relationship?

“…Indeed, we found that higher volume hospitals treated the more 27 severely ill patients. This result is consistent with the existing literature on the VOR for EOC patients in the USA (Bristow, Chang, Ziogas, Randall, & Anton-Culver, 2014;Cliby et al, 2015). We also found that the more severely ill patients and the patients treated in higher volume hospitals were more likely to be treated with neoadjuvant chemotherapy rather than primary surgery as first-line treatment.…”

Association Between Treatment at a High-Volume Facility and Improved Survival for Radiation-Treated Men With High-Risk Prostate Cancer

“…The care of prostate cancer patients necessitates multidisciplinary collaboration (21-24) among urologists, radiation oncologists, medical oncologists, radiologists, and pathologists, and a high case volume facility has higher likelihood of having experts in all the related specialties onsite. In such high-volume centers, care is likely to be well coordinated between specialists and patients are likely to be treated in a consistent fashion (11,(25)(26)(27)(28)(29), including optimal staging and selection of duration of androgen deprivation therapy, leading to better outcomes.…”

Ovarian cancer

“…The choice of physician can impact outcomes (130,131) as can adherence to the guidelines for the standard of care (132,133); surgery performed by a gynecologic oncologist results in superior outcomes and survival, compared with surgery performed by a non-gynecologic oncologist, such as a general surgeon. (Figure 4).…”