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Effect of hospital volume on processes of breast cancer care: A National Cancer Data Base study
Author(s) -
Yen Tina W. F.,
Pezzin Liliana E.,
Li Jianing,
Sparapani Rodney,
Laud Purushuttom W.,
Nattinger Ann B.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30413
Subject(s) - medicine , breast cancer , confidence interval , odds ratio , cancer , radiation therapy , logistic regression , hormonal therapy , multivariate analysis
BACKGROUND The purpose of this study was to examine variations in delivery of several breast cancer processes of care that are correlated with lower mortality and disease recurrence, and to determine the extent to which hospital volume explains this variation. METHODS Women who were diagnosed with stage I‐III unilateral breast cancer between 2007 and 2011 were identified within the National Cancer Data Base. Multiple logistic regression models were developed to determine whether hospital volume was independently associated with each of 10 individual process of care measures addressing diagnosis and treatment, and 2 composite measures assessing appropriateness of systemic treatment (chemotherapy and hormonal therapy) and locoregional treatment (margin status and radiation therapy). RESULTS Among 573,571 women treated at 1755 different hospitals, 38%, 51%, and 10% were treated at high‐, medium‐, and low‐volume hospitals, respectively. On multivariate analysis controlling for patient sociodemographic characteristics, treatment year and geographic location, hospital volume was a significant predictor for cancer diagnosis by initial biopsy (medium volume: odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.05‐1.25; high volume: OR = 1.30, 95% CI = 1.14‐1.49), negative surgical margins (medium volume: OR = 1.15, 95% CI = 1.06‐1.24; high volume: OR = 1.28, 95% CI = 1.13‐1.44), and appropriate locoregional treatment (medium volume: OR = 1.12, 95% CI = 1.07‐1.17; high volume: OR = 1.16, 95% CI = 1.09‐1.24). CONCLUSIONS Diagnosis of breast cancer before initial surgery, negative surgical margins and appropriate use of radiation therapy may partially explain the volume–survival relationship. Dissemination of these processes of care to a broader group of hospitals could potentially improve the overall quality of care and outcomes of breast cancer survivors. Cancer 2017;123:957–66. © 2016 American Cancer Society .