Gynecologic cancer patients treated at high-volume hospitals live longer

Women with gynecologic cancers live significantly longer if they’re cared for at hospitals that frequently treat such patients rather than at centers that infrequently care for them. This is according to results from a study of more than 860,000 women.¹ The research, which used the National Cancer Database to identify gynecologic cancer cases, was presented at the 2014 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer.

Results of the study

Overall, the median survival for women with all types of gynecologic cancer was 122.7 months at centers with the highest volume (nearly 300 such cases per year) compared with 110 months at the lowest-volume hospitals (<20 per year)—a difference of more than a year. The difference was even greater for cancers that are rare or require particularly complex treatment.

Patients with vaginal cancer, for example, had a median survival of 72.2 months at the highest-volume centers, compared with 38.1 months at the lowest-volume facilities—a difference of close to 3 years. For women with ovarian cancer, the difference in median survival was nearly 17 months (49.4 months for highest-volume versus 32.5 for lowest-volume).

The researchers analyzed data on 863,156 women treated for cervical, ovarian, uterine, vaginal, or vulvar cancer from 1998 to 2011. The patients received treatment at 1666 medical centers, which the researchers divided into quartiles based on the number of reproductive cancer cases treated annually.

Over the 13-year study period, the number of women with gynecologic cancer who received treatment at high-volume facilities rose steadily, said Jeff F. Lin, MD, lead author of the study and a physician in gynecologic oncology at Magee-Womens Hospital at the University of Pittsburgh Medical Center. This rise in treatment at high-volume centers did not benefit elderly patients and those with more advanced cancers, however, as these patients were more likely to receive treatment at lower-volume facilities.

Refer women to high-volume centers, say the authors

The research results did not explain why women treated at high-volume centers live longer, nor the reason more patients with gynecologic cancer are being treated at these facilities. Better coordination of care, better access to cutting-edge clinical trials, and greater likelihood of receiving care from gynecologic oncologists are possible reasons women treated at high-volume centers have better outcomes, said Dr. Lin. He added that, as gynecologic cancer care becomes more complex, physicians may feel more comfortable referring patients to high-volume centers and specialists. “Based on this and other studies, we should be trying to steer even more patients to high-volume hospitals,” he said.

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