Survival Disparities by Hospital Volume Among American Women With Gynecologic Cancers
| Autor: | Wilberto Nieves-Neira, Anna E. Strohl, Shohreh Shahabi, Brandon Luke L. Seagle, Monica Dandapani |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Databases Factual Genital Neoplasms Female Hospitals Community 03 medical and health sciences 0302 clinical medicine Interquartile range medicine Humans Registries 030212 general & internal medicine Healthcare Disparities Neoplasm Metastasis Stage (cooking) Survival rate Survival analysis Aged Neoplasm Staging Gynecology Cervical cancer Academic Medical Centers business.industry Cancer General Medicine Middle Aged medicine.disease Combined Modality Therapy Survival Analysis Hospitals United States Survival Rate Serous fluid Treatment Outcome Socioeconomic Factors Health Care Surveys 030220 oncology & carcinogenesis Female Neoplasm Grading business Clear cell |
| Zdroj: | JCO Clinical Cancer Informatics. :1-15 |
| ISSN: | 2473-4276 1998-2011 |
| DOI: | 10.1200/cci.16.00053 |
| Popis: | Purpose We describe survival disparities among women with uterine, ovarian, or cervical cancer by cancer-specific mean annual hospital volume. Methods National Cancer Database 1998-2011 uterine (n = 441,863), ovarian (n = 223,017), and cervical (n = 146,698) cancer data sets were used. Cancer-specific mean annual hospital volumes were calculated. Overall survival (OS) was plotted by hospital volume using restricted mean OS times from Cox regression. Results Uterine, ovarian, and cervical cancers were reported from 1,651, 1,633, and 1,600 hospitals, respectively. Median values of mean annual hospital volumes among hospitals were 8.6 (interquartile range [IQR], 2.6 to 20.8), 4.4 (IQR, 1.4 to 10.3), and 2.4 (IQR, 0.6 to 6.6) for uterine, ovarian, and cervical cancers, respectively. Increased hospital volume was associated with increased OS among women with stage III to IV high-grade serous ovarian cancer, stage II to IV squamous or adenocarcinoma cervical cancer, and stage I to IV endometrioid, clear cell, serous, or carcinosarcoma uterine cancers (all P < .03). Differential OS between women treated at higher- versus lower-volume cancer centers exceeded 5, 5, and 13 months among women with advanced endometrial, ovarian, or cervical cancer, respectively (all P < .001). Hospital volume was not associated with OS among patients with stage II to IV cervical cancer treated with brachytherapy ( P = .17). Use of adjuvant therapies decreased OS disparities by hospital volume among women with advanced ovarian or endometrial cancer. Conclusion Increased delivery of brachytherapy for treatment of cervical cancer may decrease survival disparities by hospital volume. Standardization of adjuvant therapies may diminish survival disparities by hospital volume among women with advanced ovarian or endometrial cancer. In addition, survival of American women with gynecologic cancer may be increased by centralization of care. |
| Databáze: | OpenAIRE |
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