Reexamining the Relationship of Breast Cancer Hospital and Surgical Volume to Mortality: An Instrumental Variable Analysis. Med Care 2015 Dec;53(12):1033-9
Date
10/23/2015Pubmed ID
26492213Pubmed Central ID
PMC4648647DOI
10.1097/MLR.0000000000000439Scopus ID
2-s2.0-84948121438 (requires institutional sign-in at Scopus site) 28 CitationsAbstract
OBJECTIVE: To reexamine the relationship of hospital and surgical volume to all-cause and breast cancer-specific mortality, taking into account the potential selection bias in patients treated at high-volume centers or by high-volume surgeons.
DATA SOURCES: Elderly (65+) women with early-stage, incident breast cancer surgery in 2003.
STUDY DESIGN: A population-based, prospective survey study.
METHODS: Two-stage, instrumental variable regression models.
PRINCIPAL FINDINGS: Women treated in high-volume hospitals were significantly less likely to die of any cause by 5 years after surgery, even after adjustments for self-selection and a number of other factors. The relationship was larger and more significant for breast cancer-specific mortality. Although the general pattern of better mortality outcomes held for moderately sized hospitals, the relationships were not statistically significant. In contrast, there was no relationship of surgeon volume with all-cause or breast cancer-specific mortality.
CONCLUSIONS: Hospital volume, but not surgeon volume, is associated with better survival among women with breast cancer. The magnitude of the potential improvement was substantial and comparable with the benefit conferred by many systemic therapies. These findings highlight the importance of accounting for patient self-selection in volume-outcome analyses, and provide support for policy initiatives aimed at regionalizing breast cancer care in the United States.
Author List
Pezzin LE, Laud P, Yen TW, Neuner J, Nattinger ABAuthors
Purushottam W. Laud PhD Adjunct Professor in the Data Science Institute department at Medical College of WisconsinAnn B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Joan Neuner MD, MPH Professor in the Medicine department at Medical College of Wisconsin
Liliana Pezzin PhD, JD 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
MESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Breast Neoplasms
Cancer Care Facilities
Female
Health Status
Hospitals, High-Volume
Humans
Neoplasm Staging
Prospective Studies
Residence Characteristics
Socioeconomic Factors
United States
