More efforts should be directed at helping patients with gynecologic cancers seek care at high-volume hospitals.
—Jeff F. Lin, MD
Women with gynecologic cancers who are treated at hospitals that frequently manage these conditions appear to live significantly longer than those who receive their care at lower-volume centers, according to a large study presented at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer, held March 22–25 in Tampa, Florida. Improved survival was observed at high-volume centers independent of prognostic factors.
In fact, life was extended by about 1 year for women with cervical, ovarian, uterine, vaginal, and vulvar cancers cared for at high-volume centers compared with those at low-volume centers. The study also showed an increasing trend over time in the number of women with gynecologic cancers who seek treatment at a high-volume center.
Increasingly Complex Care
“This trend is good news for women. Although these data don’t tell us exactly why more women are being treated at high-volume centers, gynecologic cancer care is becoming increasingly complex, and doctors may feel more comfortable referring patients to specialized high-volume centers that can better coordinate such care,” suggested lead author Jeff F. Lin, MD, Magee-Womens Hospital of University of Pittsburgh Medical Center.
“Studies have already shown that specialty care for some cancers improves the quality of care and survival. The relative rarity and diversity of gynecologic cancers suggest that they require complex management and would benefit from regionalization of care. In addition, the current environment of health-care reform encourages regionalization of cancer care into specialized centers. Based on this study and others, more efforts should be directed at helping patients with gynecologic cancers seek care at high-volume hospitals,” Dr. Lin said.
Potential reasons Dr. Lin cited for superior survival at high-volume centers include improved coordination of care, better access to clinical trials and/or cutting-edge therapy, and greater likelihood of being treated for cancers of female reproductive organs by gynecologic oncologists and allied specialists.
The study was based on data from the National Cancer Database, which is maintained by the American College of Surgeons Commission on Cancer and the American Cancer Society. The study population included 863,156 patients with female reproductive cancers treated at 1,666 centers between January 1998 and December 2011. The centers were categorized according to quartiles representing the highest-volume centers that care for nearly 300 gynecologic cancer patients per year to the lowest-volume centers caring for fewer than 20 such patients annually.
For all gynecologic cancer patients, median overall survival was 122.7 months at the highest-volume hospitals and 110 months at the lowest-volume hospitals. “This difference represents 12.7 months,” Dr. Lin stated. “A difference in survival of 12-plus months can mean that a patient can see her newborn grandchild, travel the world, or make a difference in others’ lives—all of this resting on a decision made before she even walks into the hospital.”
The difference in favor of high-volume hospitals was even greater for rare cancers and those that require complex management. For ovarian cancer, median survival was 49.4 months at the highest-volume centers vs 32.5 months at the lowest-volume centers. For vaginal cancers, median overall survival was 72.2 vs 38.1 months, respectively—a difference of nearly 3 years favoring highest-volume centers.
The number of women treated for gynecologic cancers each year remained steady at the lowest-volume centers—about 18. However, a steady increase was observed in the number of women treated at high-volume centers, particularly among the hospitals that treated the most women. At the start of the study in 1998, the highest-volume hospital treated 188 patients per year; this number rose to 291 in 2011 at the end of the study.
According to a multivariable analysis performed to identify factors associated with treatment at high-volume centers, the highest-volume centers were more likely to be more than 5 miles away from where patients lived, more likely to treat insured patients, and more likely to treat traditionally underserved populations. Elderly patients (ie, over age 71), with higher-stage cancer and more medical issues, were significantly more likely to be treated at the lowest-quartile centers.
Dr. Lin noted that this study did not address what specific components of care at high-volume centers might confer a survival advantage, whether certain best practices can be adapted in lower-volume centers, and whether regionalization of care improves efficiency and care delivery. He looks forward to studies that address these questions. ■
Disclosure: Dr. Lin reported no potential conflicts of interest.
1. Lin JF, Alexander AL, Beriwal S, et al: Characteristics of high-volume gynecologic cancer centers—framework toward centers of excellence: A National Cancer Data Base (NCDB) study. SGO Annual Meeting on Women’s Cancer. Abstract 89. Presented March 24, 2014.