Identifying patterns of breast cancer care provided at high-volume hospitals: a classification and regression tree analysis

Kong, Amanda L.; Pezzin, Liliana E.; Nattinger, Ann B.

doi:10.1007/s10549-015-3561-6

Cited by 20 publications

(6 citation statements)

References 42 publications

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“…12–15 On review of New York State data from 1984 to 1989, Roohan et al 16 demonstrated that patients receiving treatment for breast cancer at high-volume hospitals (≥150 breast surgeries performed per year) had a significantly improved survival at 5 years when compared with patients treated at lower volume centers. The authors also reported that higher mortality was associated with lower case volumes (19% in moderate-volume hospitals = 51 to 150 breast surgeries per year; 30% in low-volume hospitals = 11 to 50 breast surgeries per year; 60% in very low-volume hospitals = ≤10 breast surgeries per year).…”

Section: Discussionmentioning

confidence: 99%

“…20 Multiple studies have suggested that treatment at high-volume centers is associated with the receipt of evidence-based care, including multidisciplinary consultations, and more frequent use of breast conservation, adjuvant chemotherapy, and radiation. 6,13,15,19,20,21 Kong et al 15 demonstrated that use of sentinel lymph node biopsy was the aspect of care that most notably differed between high versus low-volume centers, and correlated with more frequent use of adjuvant therapy (including chemotherapy, radiation, and endocrine therapy) in their series. A similar phenomenon could explain the improved survival among hormone-receptor positive breast cancers seen in our study; favorable biology leaves a greater chance for cure, and decisions about systemic therapy in this population are nuanced and multifactorial.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Hospital Volume on Breast Cancer Mortality

et al. 2018

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Objective The aim of this study was to determine whether hospital volume was associated with mortality in breast cancer, and what thresholds of case volume impacted survival. Background Prior literature has demonstrated improved survival with treatment at high volume centers among less common cancers requiring technically complex surgery. Methods All adults (18 to 90 years) with stages 0–III unilateral breast cancer diagnosed from 2004 to 2012 were identified from the American College of Surgeons National Cancer Data Base (NCDB). A multivariable Cox proportional hazards model with restricted cubic splines was used to examine the association of annual hospital volume and overall survival, after adjusting for measured covariates. Intergroup comparisons of patient and treatment characteristics were conducted with X2 and analysis of variance (ANOVA). The log-rank test was used to test survival differences between groups. A multivariable Cox proportional hazards model was used to estimate hazard ratios (HRs) associated with each volume group. Results One million sixty-four thousand two hundred and fifty-one patients met inclusion criteria. The median age of the sample was 60 (interquartile range 50 to 70). Hospitals were categorized into 3 groups using restricted cubic spline analysis: low-volume (<148 cases/year), moderate-volume (148 to 298 cases/year), and high-volume (>298 cases/year). Treatment at high volume centers was associated with an 11% reduction in overall mortality for all patients (HR 0.89); those with stage 0–I, ER+/PR+ or ER+/PR− breast cancers derived the greatest benefit. Conclusions Treatment at high volume centers is associated with improved survival for breast cancer patients regardless of stage. High case volume could serve as a proxy for the institutional infrastructure required to deliver complex multidisciplinary breast cancer treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effect of Hospital Volume on Breast Cancer Mortality

et al. 2018

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“…In a comprehensive review of health services literature, hospital or physician volume or specialty has been found to affect outcome of cancer care [9]. Hospital volume has been associated with patterns of care reflecting the most current standards of care in patients with breast cancer [10]. High volume hospitals are associated with better outcomes also for different cancers types [11–17].…”

Section: Discussionmentioning

confidence: 99%

Patterns of care of brain tumor-related epilepsy. A cohort study done in Italian Epilepsy Center

et al. 2017

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Epilepsy is the most common comorbidity in patients with brain tumors. Study Aims: To define characteristics of brain tumor-related epilepsy (BTRE) patients and identify patterns of care. Nationwide, multicenter retrospective cohort study. Medical records of BTRE patients seen from 1/1/2010 to 12/31/2011, followed for at least one month were examined. Information included age, sex, tumor type/treatments, epilepsy characteristics, antiepileptic drugs (AEDs). Time to modify first AED due to inefficacy and/or toxicity was assessed with the Kaplan-Meier method and Cox proportional hazard models were used to identify predictors of treatment outcome. Enrolled were 808 patients (447 men, 361 women) from 26 epilepsy centers. Follow-up ranged 1 to 423 months (median 18 months). 732 patients underwent surgery, 483 chemotherapy (CT), 508 radiotherapy. All patients were treated with AEDs. Levetiracetam was the most common drug. 377 patients (46.7%) were still on first drug at end of follow-up, 338 (41.8%) needed treatment modifications (uncontrolled seizures, 229; side effects, 101; poor compliance, 22). Treatment discontinuation for lack of efficacy was associated with younger age, chemotherapy, and center with <20 cases. Treatment discontinuation for side effects was associated with female sex, enzyme-inducing drugs and center with > 20 cases. About one-half of patients with BTRE were on first AED at end of follow-up. Levetiracetam was the most common drug. A non enzyme-inducing AED was followed by a lower risk of drug discontinuation for SE.

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“…Although better care has generally been observed among breast cancer patients treated by high-volume surgeons, none of the previously published studies have used the EUSOMA criteria to assess the quality of care received. As reported in previous studies, we found that surgeons who performed >10 operations/year more frequently performed a histological assessment before surgery [37,38], removed sentinel lymph nodes when indicated [39][40][41][42][43], removed an adequate number of axillary lymph nodes when performing axillary clearance [44,45], and referred their patients for adjuvant radiotherapy when indicated [5,45,46].…”

Section: What Was Already Known On the Topic?mentioning

confidence: 62%

Impact of experience in breast cancer surgery on survival: the role of quality of care in a registry-based cohort

Taban¹,

Elia

Rapiti

et al. 2019

Swiss Med Wkly

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AIMS OF THE STUDY: Previous studies have suggested that the surgeon's experience in breast cancer surgery may affect patient survival. In this registry-based retrospective cohort study, we examined whether quality of care could partly explain this association. METHODS: All invasive breast cancers operated on in the private sector between 2000 and 2009 were identified in the Geneva Cancer Registry and followed up for 5 years. Surgeons were classified according to their experience into three categories: ≤5, 6-10, >10 breast cancer operations performed per year. We extracted patient and tumour characteristics. Quality of care was scored as the proportion of 11 quality indicators correctly fulfilled for each patient. Breast cancer-specific mortality was examined with a Cox model adjusted for variables known to affect survival, surgeon experience, and quality of care. RESULTS: A total of 1489 patients were operated on by 88 surgeons; 50 patients (3.4%) died from breast cancer during the 5 years of follow-up. Socioeconomic status and country of birth of the patients, as well as period of diagnosis, differed according to the surgeons' experience. Quality of care provided improved with surgeon's experience. Surgeons performing >10 operations/year more frequently assessed histology before surgery, excised sentinel lymph nodes, removed ≥10 lymph nodes, and prescribed adjuvant radiotherapy when indicated. Crude breast cancerspecific mortality was lower in patients treated by surgeons performing >10 compared with ≤5 operations/year (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.17-0.67; p = 0.002). The strength of the association decreased after adjustment for patient and tumour characteristics (HR 0.45, 95% CI 0.21-0.94; p = 0.034) and decreased further after adjustment for quality of care (HR 0.51, 95% CI 0.24-1.08, p = 0.078). CONCLUSIONS:The association between surgeon's experience and 5-year breast cancer survival is at least part-ly explained by quality of care, patient and tumour characteristics. Further investigations on the impact of other quality indicators such as multidisciplinary networks are needed.

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Identifying patterns of breast cancer care provided at high-volume hospitals: a classification and regression tree analysis

Cited by 20 publications

References 42 publications

The Effect of Hospital Volume on Breast Cancer Mortality

The Effect of Hospital Volume on Breast Cancer Mortality

Patterns of care of brain tumor-related epilepsy. A cohort study done in Italian Epilepsy Center

Impact of experience in breast cancer surgery on survival: the role of quality of care in a registry-based cohort

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