High facility volume improved gynecologic cancer survival

Patients with gynecologic cancer treated at high-volume medical centers survived significantly longer than those treated at low-volume centers, according to study results presented at the Society of Gynecologic Oncology Annual Meeting on Women’s Cancer in Tampa, Fla.

The number of women treated at high-volume centers increased during the study period, but elderly patients and those with advanced-stage disease were more likely to be treated at low-volume centers.

“This trend is good news for women,” study researcher Jeff F. Lin, MD, of Magee-Women’s Hospital of the University of Pittsburgh Medical Center, said in a press release. “Although these data don’t tell us why more women are being treated at high-volume centers, gynecologic cancer care is becoming increasingly complicated, and doctors may feel more comfortable referring patients to high-volume centers.”

Lin and colleagues used the cervical, uterine, ovarian, vaginal and vulvar datasets of the National Cancer Data Base to identify 863,156 patients treated between 1998 and 2011 at 1,666 centers.

Researchers categorized the medical centers into first (n=64), second (n=120), third (n=235) and fourth quartiles (n=1,247) according to case volume.

The average highest-volume hospital treated 188 patients a year when the study began in 1998. That number increased to 291 patients a year in 2011. The average lowest-volume hospital treated 18 women a year in 1998, and that figure remained consistent during the study period.

Overall, centers in the top quartile were more likely to be academic or research-based programs located more than 30 miles from their patients. All community cancer programs were in the third and fourth quartiles.

The highest-volume centers were more likely to administer chemotherapy to and perform lymphadenectomy on patients whose disease had advanced beyond stage II. Researchers found patients older than 71 years, those with stage IV disease and those with insurance were more likely to be treated at the lowest quartile centers.

Patients treated at top quartile centers experienced a disease-site survival advantage ranging from 2.3 months among patients with vulvar cancer (P˂.0005) to 34.1 months among patients with vaginal cancer (P˂.0005) compared with those treated at centers in the lowest quartile.

Researchers noted median OS differences were not statistically different between the highest and lowest quartile centers among patients with uterine cancer (159.7 months vs. 156.2 months; P=.6).

Overall, low-volume centers were associated with a 10% increase in the risk for mortality when adjusted for age, stage and comorbidities (OR=1.1; 95% CI, 1.07-1.12).

“Based on this and other studies, we should be trying to steer even more patients to high-volume hospitals,” Lin said.

For more information:

Lin JF. Abstract #89. Presented at: Society of Gynecologic Oncology Annual Meeting; March 22-24, 2014; Tampa, Fla.

Disclosure: See the study for a full list of the researchers’ relevant financial disclosures.