Will Patients Benefit from Regionalization of Gynecologic Cancer Care?

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2009 Jan 7

PMID 19125205

Citations 6

Authors

Kathleen F Brookfield

Michael C Cheung

Relin Yang

Margaret M Byrne

Leonidas G Koniaris

Affiliations

Soon will be listed here.

Abstract

Objective: Patient chances for cure and palliation for a variety of malignancies may be greatly affected by the care provided by a treating hospital. We sought to determine the effect of volume and teaching status on patient outcomes for five gynecologic malignancies: endometrial, cervical, ovarian and vulvar carcinoma and uterine sarcoma.

Methods: The Florida Cancer Data System dataset was queried for all patients undergoing treatment for gynecologic cancers from 1990-2000.

Results: Overall, 48,981 patients with gynecologic malignancies were identified. Endometrial tumors were the most common, representing 43.2% of the entire cohort, followed by ovarian cancer (30.9%), cervical cancer (20.8%), vulvar cancer (4.6%), and uterine sarcoma (0.5%). By univariate analysis, although patients treated at high volume centers (HVC) were significantly younger, they benefited from an improved short-term (30-day and/or 90-day) survival for cervical, ovarian and endometrial cancers. Multivariate analysis (MVA), however, failed to demonstrate significant survival benefit for gynecologic cancer patients treated at teaching facilities (TF) or HVC. Significant prognostic factors at presentation by MVA were age over 65 (HR = 2.6, p<0.01), African-American race (HR = 1.36, p<0.01), and advanced stage (regional HR = 2.08, p<0.01; advanced HR = 3.82, p<0.01, respectively). Surgery and use of chemotherapy were each significantly associated with improved survival.

Conclusion: No difference in patient survival was observed for any gynecologic malignancy based upon treating hospital teaching or volume status. Although instances of improved outcomes may occur, overall further regionalization would not appear to significantly improve patient survival.

Citing Articles

Impact of Cancer Care Regionalization on Patient Volume.

Contrera K, Tam S, Pytynia K, Diaz Jr E, Hessel A, Goepfert R Ann Surg Oncol. 2022; 30(4):2331-2338.

PMID: 36581726 DOI: 10.1245/s10434-022-13029-3.

Regionalization for health improvement: A systematic review.

Ramos M, Barreto J, Shimizu H, Moraes A, Silva E PLoS One. 2020; 15(12):e0244078.

PMID: 33351841 PMC: 7755212. DOI: 10.1371/journal.pone.0244078.

Impact of hospital volume on racial disparities and outcomes for endometrial cancer.

Buskwofie A, Huang Y, Tergas A, Hou J, Ananth C, Neugut A Gynecol Oncol. 2018; 149(2):329-336.

PMID: 29506862 PMC: 5915905. DOI: 10.1016/j.ygyno.2018.02.019.

Trends in the receipt of guideline care and survival for women with ovarian cancer: A population-based study.

Warren J, Harlan L, Trimble E, Stevens J, Grimes M, Cronin K Gynecol Oncol. 2017; 145(3):486-492.

PMID: 28372872 PMC: 5489119. DOI: 10.1016/j.ygyno.2017.03.016.

The optimal organization of gynecologic oncology services: a systematic review.

Fung-Kee-Fung M, Kennedy E, Biagi J, Colgan T, DSouza D, Elit L Curr Oncol. 2015; 22(4):e282-93.

PMID: 26300679 PMC: 4530826. DOI: 10.3747/co.22.2482.

References

Riall T, Eschbach K, Townsend Jr C, Nealon W, Freeman J, Goodwin J . Trends and disparities in regionalization of pancreatic resection. J Gastrointest Surg. 2007; 11(10):1242-51. DOI: 10.1007/s11605-007-0245-5. View

Mayer A, Chambers S, Graves E, Holm C, Tseng P, Nelson B . Ovarian cancer staging: does it require a gynecologic oncologist?. Gynecol Oncol. 1992; 47(2):223-7. DOI: 10.1016/0090-8258(92)90110-5. View

Hoekstra A, Singh D, Garb M, Arekapudi S, Rademaker A, Lurain J . Participation of the general gynecologist in surgical staging of endometrial cancer: analysis of cost and perioperative outcomes. Gynecol Oncol. 2006; 103(3):897-901. DOI: 10.1016/j.ygyno.2006.05.019. View

Hillner B, Smith T, Desch C . Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000; 18(11):2327-40. DOI: 10.1200/JCO.2000.18.11.2327. View

Nguyen H, AVERETTE H, Hoskins W, Penalver M, Sevin B, Steren A . National survey of ovarian carcinoma. Part V. The impact of physician's specialty on patients' survival. Cancer. 1993; 72(12):3663-70. DOI: 10.1002/1097-0142(19931215)72:12<3663::aid-cncr2820721218>3.0.co;2-s. View

Puls L, Carrasco R, Morrow M, Blackhurst D . Stage I ovarian carcinoma: specialty-related differences in survival and management. South Med J. 1997; 90(11):1097-100. DOI: 10.1097/00007611-199711000-00008. View

Diaz-Montes T, Zahurak M, Giuntoli 2nd R, Gardner G, Bristow R . Uterine cancer in Maryland: impact of surgeon case volume and other prognostic factors on short-term mortality. Gynecol Oncol. 2006; 103(3):1043-7. DOI: 10.1016/j.ygyno.2006.06.018. View

Panageas K, Schrag D, Riedel E, Bach P, Begg C . The effect of clustering of outcomes on the association of procedure volume and surgical outcomes. Ann Intern Med. 2003; 139(8):658-65. DOI: 10.7326/0003-4819-139-8-200310210-00009. View

Hodgson N, Koniaris L, Livingstone A, Franceschi D . Gastric carcinoids: a temporal increase with proton pump introduction. Surg Endosc. 2005; 19(12):1610-2. DOI: 10.1007/s00464-005-0232-4. View

10.

Gutierrez J, Kassira N, Salloum R, Franceschi D, Koniaris L . Surgery for rectal cancer performed at teaching hospitals improves survival and preserves continence. J Gastrointest Surg. 2007; 11(11):1441-8. DOI: 10.1007/s11605-007-0308-7. View

11.

Silber J, Rosenbaum P, Polsky D, Ross R, Even-Shoshan O, Schwartz J . Does ovarian cancer treatment and survival differ by the specialty providing chemotherapy?. J Clin Oncol. 2007; 25(10):1169-75. DOI: 10.1200/JCO.2006.08.2933. View

12.

Diaz-Montes T, Zahurak M, Giuntoli 2nd R, Bristow R . Concentration of uterine cancer surgical care among the elderly: a population-based perspective. Gynecol Oncol. 2007; 107(3):436-40. DOI: 10.1016/j.ygyno.2007.07.060. View

13.

Molina M, Cheung M, Perez E, Byrne M, Franceschi D, Moffat F . African American and poor patients have a dramatically worse prognosis for head and neck cancer: an examination of 20,915 patients. Cancer. 2008; 113(10):2797-806. DOI: 10.1002/cncr.23889. View

14.

Bristow R, Zahurak M, Carmen M, Gordon T, Fox H, Trimble E . Ovarian cancer surgery in Maryland: volume-based access to care. Gynecol Oncol. 2004; 93(2):353-60. DOI: 10.1016/j.ygyno.2004.02.010. View

15.

Perez E, Koniaris L, Snell S, Gutierrez J, Sumner 3rd W, Lee D . 7201 carcinoids: increasing incidence overall and disproportionate mortality in the elderly. World J Surg. 2007; 31(5):1022-30. DOI: 10.1007/s00268-005-0774-6. View

16.

Junor E, Hole D, McNulty L, Mason M, Young J . Specialist gynaecologists and survival outcome in ovarian cancer: a Scottish national study of 1866 patients. Br J Obstet Gynaecol. 1999; 106(11):1130-6. DOI: 10.1111/j.1471-0528.1999.tb08137.x. View

17.

Carney M, Lancaster J, Ford C, Tsodikov A, Wiggins C . A population-based study of patterns of care for ovarian cancer: who is seen by a gynecologic oncologist and who is not?. Gynecol Oncol. 2001; 84(1):36-42. DOI: 10.1006/gyno.2001.6460. View

18.

Cheung M, Perez E, Molina M, Jin X, Gutierrez J, Franceschi D . Defining the role of surgery for primary gastrointestinal tract melanoma. J Gastrointest Surg. 2007; 12(4):731-8. DOI: 10.1007/s11605-007-0417-3. View

19.

Gutierrez J, Perez E, Moffat F, Livingstone A, Franceschi D, Koniaris L . Should soft tissue sarcomas be treated at high-volume centers? An analysis of 4205 patients. Ann Surg. 2007; 245(6):952-8. PMC: 1876958. DOI: 10.1097/01.sla.0000250438.04393.a8. View

20.

Perez E, Livingstone A, Franceschi D, Rocha-Lima C, Lee D, Hodgson N . Current incidence and outcomes of gastrointestinal mesenchymal tumors including gastrointestinal stromal tumors. J Am Coll Surg. 2006; 202(4):623-9. DOI: 10.1016/j.jamcollsurg.2006.01.002. View