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Effect of hospital volume on processes of breast cancer care: A National Cancer Data Base study. Cancer 2017 05 15;123(6):957-966 PMID: 27861746

Pubmed ID

27861746

DOI

10.1002/cncr.30413

Abstract

BACKGROUND: The purpose of this study was to examine variations in delivery of several breast cancer processes of care that are correlated with lower mortality and disease recurrence, and to determine the extent to which hospital volume explains this variation.

METHODS: Women who were diagnosed with stage I-III unilateral breast cancer between 2007 and 2011 were identified within the National Cancer Data Base. Multiple logistic regression models were developed to determine whether hospital volume was independently associated with each of 10 individual process of care measures addressing diagnosis and treatment, and 2 composite measures assessing appropriateness of systemic treatment (chemotherapy and hormonal therapy) and locoregional treatment (margin status and radiation therapy).

RESULTS: Among 573,571 women treated at 1755 different hospitals, 38%, 51%, and 10% were treated at high-, medium-, and low-volume hospitals, respectively. On multivariate analysis controlling for patient sociodemographic characteristics, treatment year and geographic location, hospital volume was a significant predictor for cancer diagnosis by initial biopsy (medium volume: odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.05-1.25; high volume: OR = 1.30, 95% CI = 1.14-1.49), negative surgical margins (medium volume: OR = 1.15, 95% CI = 1.06-1.24; high volume: OR = 1.28, 95% CI = 1.13-1.44), and appropriate locoregional treatment (medium volume: OR = 1.12, 95% CI = 1.07-1.17; high volume: OR = 1.16, 95% CI = 1.09-1.24).

CONCLUSIONS: Diagnosis of breast cancer before initial surgery, negative surgical margins and appropriate use of radiation therapy may partially explain the volume-survival relationship. Dissemination of these processes of care to a broader group of hospitals could potentially improve the overall quality of care and outcomes of breast cancer survivors. Cancer 2017;123:957-66. © 2016 American Cancer Society.

Author List

Yen TW, Pezzin LE, Li J, Sparapani R, Laud PW, Nattinger AB

Authors

Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Liliana Pezzin PhD, JD Professor in the Medicine department at Medical College of Wisconsin
Rodney Sparapani PhD Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-84998953404   6 Citations

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Breast Neoplasms
Combined Modality Therapy
Databases, Factual
Delivery of Health Care
Disease Management
Female
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Middle Aged
Neoplasm Grading
Neoplasm Staging
Odds Ratio
Outcome Assessment (Health Care)
Quality of Health Care
Socioeconomic Factors
Time-to-Treatment
United States
jenkins-FCD Prod-332 f92a19b0ec5e8e1eff783fac390ec127e367c2b5