Impact of National Cancer Institute Comprehensive Cancer Centers on Ovarian Cancer Treatment and Survival - 22/04/15
, Jenny Chang, MPH b, Argyrios Ziogas, PhD b, Belinda Campos, PhD c, Leo R. Chavez, PhD c, Hoda Anton-Culver, PhD bAbstract |
Background |
The regional impact of care at a National Cancer Institute Comprehensive Cancer Center (NCI-CCC) on adherence to National Comprehensive Cancer Network (NCCN) ovarian cancer treatment guidelines and survival is unclear.
Study Design |
We performed a retrospective population-based study of consecutive patients diagnosed with epithelial ovarian cancer between January 1, 1996 and December 31, 2006 in southern California. Patients were stratified according to care at an NCI-CCC (n = 5), non-NCI high-volume hospital (≥10 cases/year, HVH, n = 29), or low-volume hospital (<10 cases/year, LVH, n = 158). Multivariable logistic regression and Cox-proportional hazards models were used to examine the effect of NCI-CCC status on treatment guideline adherence and ovarian cancer-specific survival.
Results |
A total of 9,933 patients were identified (stage I, 22.8%; stage II, 7.9%; stage III, 45.1%; stage IV, 24.2%), and 8.1% of patients were treated at NCI-CCCs. Overall, 35.7% of patients received NCCN guideline adherent care, and NCI-CCC status (odds ratio [OR] 1.00) was an independent predictor of adherence to treatment guidelines compared with HVHs (OR 0.83, 95% CI 0.70 to 0.99) and LVHs (OR 0.56, 95% CI 0.47 to 0.67). The median ovarian cancer-specific survivals according to hospital type were: NCI-CCC 77.9 (95% CI 61.4 to 92.9) months, HVH 51.9 (95% CI 49.2 to 55.7) months, and LVH 43.4 (95% CI 39.9 to 47.2) months (p < 0.0001). National Cancer Institute Comprehensive Cancer Center status (hazard ratio [HR] 1.00) was a statistically significant and independent predictor of improved survival compared with HVH (HR 1.18, 95% CI 1.04 to 1.33) and LVH (HR 1.30, 95% CI 1.15 to 1.47).
Conclusions |
National Cancer Institute Comprehensive Cancer Center status is an independent predictor of adherence to ovarian cancer treatment guidelines and improved ovarian cancer-specific survival. These data validate NCI-CCC status as a structural health care characteristic correlated with superior ovarian cancer quality measure performance. Increased access to NCI-CCCs through regional concentration of care may be a mechanism to improve clinical outcomes.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : HR, HVH, LVH, NCI-CCC, NCCN, OR, SES
Plan
| Disclosure Information: Nothing to disclose. |
|
| Support: Dr Bristow was supported in part by the Queen of Hearts Foundation. The sponsor had no role in the design of the study, collection, analysis, and interpretation of the data, writing of the manuscript, or the decision to submit the manuscript for publication. |
Vol 220 - N° 5
P. 940-950 - mai 2015 Retour au numéro
Article précédent
- A Decade of Excellent Outcomes after Surgical Intervention in 538 Patients with Thoracic Outlet Syndrome
- Megan S. Orlando, Kendall C. Likes, Serene Mirza, Yue Cao, Anne Cohen, Ying Wei Lum, Thomas Reifsnyder, Julie A. Freischlag
- Hospital Resource Use with Donation after Cardiac Death Allografts in Liver Transplantation: A Matched Controlled Analysis from 2007 to 2011
- Ashish Singhal, Koffi Wima, Richard S. Hoehn, R. Cutler Quillin, E. Steve Woodle, Ian M. Paquette, Flavio Paterno, Daniel E. Abbott, Shimul A. Shah
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?