Women with ovarian and other gynecologic cancers live significantly longer when they receive care at hospitals that treat a large number of patients with these conditions, according to research on more than 850,000 women. The findings, based on information from the nation's largest cancer database, are being presented at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women's Cancer in Tampa, Fla., March 22-25.
Women with cervical, ovarian, uterine, vaginal and vulvar cancer who were cared for at high-volume centers lived about a year longer than those cared for at low-volume centers, the study found. The number of women treated at high-volume centers steadily increased during the course of the 13-year study.
"This trend is good news for women. 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 and specialists," said Jeff F. Lin, MD, lead author of the study and a physician in the division of gynecologic oncology at Magee-Womens Hospital of University of Pittsburgh Medical Center. "Based on this and other studies, we should be trying to steer even more patients to high-volume hospitals."
Dr. Lin said there are a number of possible reasons women treated at high-volume centers live longer, including better coordination of care, better access to clinical trials that offer the most cutting-edge therapy, and greater likelihood of being treated by gynecologic oncologists, who specialize in the treatment and management of female reproductive cancers.
Researchers retrieved data from the National Cancer Database (maintained by the American College of Surgeons Commission on Cancer and American Cancer Society), identifying 863,156 female reproductive cancer patients treated at 1,666 centers. Centers providing care were divided into four quartiles, from the highest-volume centers (those that care for nearly 300 gynecologic cancer patients a year) to the lowest-volume centers (those that care for fewer than 20 patients a year). The median overall survival was 122.7 months for all gynecologic cancer patients treated in the highest-volume hospitals and 110 months for those treated in the lowest-volume hospitals, a difference of more than a year (12.7 months).
The difference was even more pronounced for certain specific cancers that are rare or require complex management. For example, the median survival was 49.4 months for ovarian cancer patients treated at the highest-volume centers vs. 32.5 months for those treated at the lowest-volume centers, a nearly 17-month difference. Median survival was 72.2 months for vaginal cancer patients treated at the highest-volume centers vs. 38.1 months for those treated at the lowest-volume centers, a difference of nearly three years (34 months).
While the number of women treated yearly at each of the lowest-volume centers remained the same during the course of the study -- about 18 per year -- the number of women treated at high-volume centers steadily increased, particularly among those hospitals that treated the most patients. The average highest-volume hospital treated 188 patients a year in 1998 when the study began and 291 patients in 2011 when the study ended.
However, elderly patients and those whose disease was more advanced were less likely to be treated at high-volume facilities. The older the patient, the less likely she would be treated at a high-volume center. For example, a 75-year-old patient was 20 percent less likely to be treated at a high-volume center than a 50-year-old patient.
"These and other findings highlight areas to target for future improvement," said Dr. Lin.
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