The National Cancer Database report on advanced-stage epithelial ovarian cancer: Impact of hospital surgical case volume on overall survival and surgical treatment paradigm
Introduction
The American Cancer Society estimated that 21,550 women in the United States will be diagnosed with ovarian cancer in 2009, and 14,600 women will die of this disease [1]. While advances in novel chemotherapeutic agents and treatment strategies continue to show incremental benefits in survival, recent attention has focused on the potential for improved healthcare outcomes through concentration of cancer services. For example, Hillner et al. [2] reported findings of a comprehensive review of the health services literature and found that across all studies, the absolute benefit from care at high-volume centers exceeded the benefit from breakthrough treatments and concluded that efforts to concentrate the initial care for all forms of cancer should be undertaken. A number of population-based studies have demonstrated that the surgical expertise and multidisciplinary care provided to patients with ovarian cancer by high-volume surgeons and high-volume centers is superior when compared to low-volume providers [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]. However, other investigators have reported contradictory findings [13], [14], [15]. With recent attention focused on improving the quality of cancer care, correlative clinical outcome data for healthcare delivery system characteristics can play an important role in quality improvement efforts. Therefore, the potential relationship between hospital ovarian cancer case volume and meaningful clinical outcomes must be clearly defined.
The National Cancer Data Base (NCDB) is a joint program of the American College of Surgeons Commission on Cancer and the American Cancer Society and serves to collect data for research and quality improvement. Established in 1985, the NCDB contains data from approximately 20 million patients from more than 1430 participating hospitals, and captures nearly 80% of newly diagnosed cancers in the United States each year. The NCDB collects patient demographics, tumor characteristics, clinical and pathologic TNM stage classification, treatments administered, and survival data [16], [17], [18], [19], [20]. The objective of this study was to examine and attempt to quantify the effect of hospital procedure volume on overall survival and processes of care for women with advanced-stage invasive epithelial ovarian cancer within the context of demographic and disease-related prognostic factors using the NCDB.
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Methods
Approval to conduct this study was obtained from the Johns Hopkins Medical Institutions Clinical Research Committee and Joint Commission on Clinical Investigation, and the requirement for informed patient consent was waived (IRB study #NA00037503). Invasive epithelial ovarian patients diagnosed between January 1, 1996, and December 31, 2005, were selected from the NCDB by topography code C56.9 (epithelial histologic types 8010 to 8569; 8940 to 8949; 9000) according to the International
Results
At the time of analysis, the NCDB contained 111,557 adult female patients aged ≥ 18 years at the time of invasive epithelial ovarian cancer diagnosis from 1996 through 2005. Of that total patient pool, 45,929 patients were classified as having pathologic FIGO/AJCC Stage IIIC or IV disease and were treated with either surgery followed by chemotherapy, neo-adjuvant chemotherapy followed by surgery, or surgery alone and were treated at hospitals with ≥ 7 years of reported data. A total of 1184
Discussion
Concentration of cancer care services has been advocated on the basis of improved clinical outcomes associated with clinicians and centers providing high-volume clinical practices. With regard to ovarian cancer, the Society of Surgical Oncology has provided the following guidelines for surgery: “Surgeons undertaking operations for possible ovarian cancer should have both the necessary technical expertise and a thorough understanding of the management of the disease itself…optimal treatment of
Conflict of interest statement
No authors have a conflict of interest to declare.
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