Impact of facility volume on outcomes in patients with squamous cell carcinoma of the anal canal: Analysis of the National Cancer Data Base

Amini, Arya; Jones, Bernard L.; Ghosh, Debashis; Schefter, Tracey E.; Goodman, Karyn A.

doi:10.1002/cncr.30327

Cited by 37 publications

(38 citation statements)

References 40 publications

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“…Treatment facilities treating 3 or fewer cases over the time period examined appeared to have worse overall survival compared to centers with more experience. These findings are similar to other studies which demonstrate that patients who receive cancer treatment at lower volume centers have worse survival outcomes [4,8,[15][16][17][18][19][20][21][22]. The majority of these studies, however, tend to report on the relationship between hospital and surgical volume with outcomes [6,[15][16][17][18][19]23], and there are fewer studies investigating radiation or concurrent chemoradiation therapy [4,10,24].…”

Section: Discussionsupporting

confidence: 86%

Impact of Facility Radiation Patient Volume on Overall Survival in Patients with Muscle Invasive Bladder Cancer Undergoing Trimodality Bladder Preservation Therapy

Fischer‐Valuck

Rudra

Gabani

et al. 2019

BLC

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Background: There is an association between higher hospital and urologist case volume and improved survival outcomes for patients with bladder cancer. Less data on facility volume and outcomes exists following trimodality bladder preservation with TURBT followed by definitive chemoradiation (CRT). Materials and Methods: The National Cancer Database was queried for patients from 2004-2013 with urothelial bladder cancer (cT2-4aN0M0) receiving definitive CRT after TURBT. We compared OS between high-and low-bladder preservation case volume (BPCV) centers using Cox proportional hazard models. BPCV was dichotomized into high versus low volume at the 70th percentile level (i.e. high volume defined as top 30th percentile of cases and low volume defined as bottom 70th percentile of cases). Propensity matching was performed to match high-and low-volume centers. Results: A total of 666 treatment facilities treating 1,635 patients with bladder preservation were identified with a median follow-up of 26 months (range, 2-136 months). A 70th percentile cutoff identified 497 patients that received treatment at 64 high-volume facilities. Median OS of patients treated at high BPCV centers was 37.0 months (95% CI, 27.3-46.7) versus 32.3 months (95% CI, 27.9-33.6) for patients treated at low BPCV centers (P = 0.004). High BPCV facilities were independently associated with a decreased hazard of death (HR, 0.86, 95% CI, 0.75-0.98; P = 0.031). In the propensity score matched cohort, median OS of patients treated at high BPCV was 36.1 months (95% CI, 26.5-45.8) versus 28.1 months (95% CI, 23.9-32.3) for patients treated at a low BPCV facility (P = 0.016). Conclusions: In this observational cohort, treatment at a high BPCV facility was associated with improved OS. Causal factors for this finding may include superior bladder specific clinician expertise, technology, and multidisciplinary-care.

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Section: Discussionsupporting

confidence: 86%

Impact of Facility Radiation Patient Volume on Overall Survival in Patients with Muscle Invasive Bladder Cancer Undergoing Trimodality Bladder Preservation Therapy

Fischer‐Valuck

Rudra

Gabani

et al. 2019

BLC

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“…[37] Given the well-established relationship between hospital characteristics, such as operative volume and teaching status with improved outcomes among patients with cancer, there have been increased efforts by policymakers and hospital administrators within the United States to promote regionalization of care for complex surgical conditions. [14,43,44] [45,46] The relative impact of insurance status on regionalization of care to major, urban teaching hospitals has not, however, been wellstudied. In the current study, compared with privately insured patients, individuals who were insured by Medicaid were at a markedly decreased odds of undergoing surgery for HP cancers at urban non-teaching (OR 0.36) and urban teaching hospitals (OR 0.54).…”

Section: Discussionmentioning

confidence: 99%

Insurance Coverage Type Impacts Hospitalization Patterns Among Patients with Hepatopancreatic Malignancies

Mehta

Sahara

Merath

et al. 2020

Journal of Gastrointestinal Surgery

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Introduction: Disparities in health and healthcare access remain a major problem in the United States. The current study sought to investigate the relationship between patient insurance status and hospital selection for surgical care. Methods: Patients who underwent liver or pancreatic resection for cancer between 2004 and 2014 were identified in the National Inpatient Sample. The association of insurance status and hospital type was examined. Results: In total, 22,254 patients were included in the study. Compared with patients with private insurance, Medicaid patients were less likely to undergo surgery at urban non-teaching hospitals (OR=0.36, 95%CI 0.22-0.59) and urban teaching hospitals (OR=0.54, 95%CI 0.34-0.84) than rural hospitals. Medicaid patients were less likely to undergo surgery at private investor-owned hospitals (OR=0.53, 95%CI 0.38-0.73) than private non-profit hospitals. In contrast, uninsured patients were 2.2-fold more likely to go to government funded hospitals rather than private nonprofit hospitals (OR=2.19, 95%CI 1.76-2.71). Conclusion: Insurance status was strongly associated with the type of hospital in which patients underwent surgery for liver and pancreatic cancers. Addressing the reasons for inequitable access to different hospital settings relative to insurance status is essential to ensure that all patients undergoing pancreatic or liver surgery receive high quality surgical care.

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“…Volume-outcome analyses evaluating nonsurgical cancer outcomes are scarce and have primarily focused on hospital-level case volume and overall survival for select malignancies, [36][37][38][39] including NHL. 37 More recently, our group found that Medicare beneficiaries with newly diagnosed DLBCL were more likely to receive standard immunochemotherapy and have better survival when managed by oncologists with greater experience treating older adults with lymphoma.…”

Section: Discussionmentioning

confidence: 99%

“…This contrasts with previous analyses evaluating facility-level volume-outcome relationships in cancer, wherein treatment details were limited. [36][37][38][39]42 Finally, we included physician-level variables from the AMA Physician Masterfile to minimize unmeasured variables that could have influenced the study findings.…”

Section: Discussionmentioning

confidence: 99%

Physician Experience and Risk of Rituximab Discontinuation in Older Adults With Non-Hodgkin’s Lymphoma

Huntington

Hoag

Wang

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: Provider experience, or clinical volume, is associated with improved outcomes in many complex healthcare settings. Despite increased complexity of anticancer therapies, studies evaluating physician-level experience and cancer treatment outcomes are lacking. Methods: A population-based study was conducted of older adults (aged ≥66 years) diagnosed with B-cell non-Hodgkin’s lymphoma in 2004 through 2011 using SEER-Medicare data. Analysis focused on outcomes in patients receiving rituximab, the first approved monoclonal anticancer immunotherapy. We hypothesized that lower physician experience using rituximab and managing its infusion-related reactions would be associated with early treatment discontinuation. A 12-month look-back from each initiation of rituximab was used to categorize physician volume (0, 1–2, or ≥3 initiations per year). Modified Poisson regression was used to account for provider-level correlation and estimated relative risk (RR) of early rituximab discontinuation (<3 cycles within 180 days of rituximab initiation). Cox proportional hazards were used to measure the impact of rituximab discontinuation on survival. Results: Among 15,110 patients who initiated rituximab with 2,684 physicians, 7.6% experienced early rituximab discontinuation. Approximately one-fourth of patients (26.1%) initiated rituximab with a physician who had no rituximab initiations during the preceding 12 months. Compared with patients treated by physicians who had ≥3 rituximab initiations in the prior year, those treated by physicians without initiations were 57% more likely to experience early discontinuation (adjusted RR [aRR], 1.57; 95% CI, 1.35–1.82; P<.001 for 0 vs ≥3, and aRR, 1.19; 95% CI, 1.03–1.37; P=.02 for 1–2 vs ≥3). Additionally, rituximab discontinuation was associated with higher risk of death (adjusted hazard ratio, 1.39; 95% CI, 1.28–1.52; P<.001). Conclusions: Lower oncologist experience with rituximab was associated with increased risk of early rituximab discontinuation in Medicare beneficiaries with non-Hodgkin’s lymphoma. Physician-level volume may be an important factor in providing high-quality cancer care in the modern era.

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Impact of facility volume on outcomes in patients with squamous cell carcinoma of the anal canal: Analysis of the National Cancer Data Base

Cited by 37 publications

References 40 publications

Impact of Facility Radiation Patient Volume on Overall Survival in Patients with Muscle Invasive Bladder Cancer Undergoing Trimodality Bladder Preservation Therapy

Impact of Facility Radiation Patient Volume on Overall Survival in Patients with Muscle Invasive Bladder Cancer Undergoing Trimodality Bladder Preservation Therapy

Insurance Coverage Type Impacts Hospitalization Patterns Among Patients with Hepatopancreatic Malignancies

Physician Experience and Risk of Rituximab Discontinuation in Older Adults With Non-Hodgkin’s Lymphoma

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