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Okuyama, Ayako, Yoichiro Tsukada, and Takahiro Higashi. "Coverage of the hospital-based cancer registries and the designated cancer care hospitals in Japan." Japanese Journal of Clinical Oncology 51, no. 6 (April 14, 2021): 992–98. http://dx.doi.org/10.1093/jjco/hyab036.
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Abstract Background Hospital-based cancer registries were developed to describe and improve clinical care for cancer patients. We described the hospital-based cancer registry coverage as a reference for the users, including researchers, policymakers and clinicians. Methods The hospital-based cancer registry coverage was defined as the proportion of new cases registered in the hospital-based cancer registry to the National Cancer Registry as the denominator. To examine the coverage of respective cancer types, age groups and prefecture in the hospital-based cancer registry, cases were grouped based on the 10th International Statistical Classification of Diseases and Related Health Problems and were compared with the published report of the National Cancer Registry in 2017. Results The overall hospital-based cancer registries coverage was 71.7%, and 52.5% of patients were treated at designated cancer care hospitals. The hospital-based cancer registries coverage and treatment rates at designated cancer care hospitals varied per cancer type, age group, and prefecture. The hospital-based cancer registries covered over 80% of the patients with cancers of the larynx, uterus, oesophagus, lip, oral cavity, pharynx and skin, whereas patients’ coverage with thyroid cancer was relatively low. The hospital-based cancer registry coverage of young patients (<15 years) was >80%, whereas that for elderly patients (≥85 years) was <55%. The range of coverage in each prefecture was from 43.0 to 89.7%. Over 70% of the patients with cancers of the larynx, lip, oral cavity and pharynx were treated at designated cancer care hospitals. Conclusions The hospital-based cancer registry coverage is ~70% of all cancers. Because the coverage differed across cancers and age groups, the respective target groups’ analysis should consider this factor.
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Yang, Annie, Susan Chimonas, Peter B. Bach, David J. Taylor, and Allison Lipitz-Snyderman. "Critical Choices: What Information Do Patients Want When Selecting a Hospital for Cancer Surgery?" Journal of Oncology Practice 14, no. 8 (August 2018): e505-e512. http://dx.doi.org/10.1200/jop.17.00031.
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Purpose: Access to comparative information on hospitals’ quality of cancer care is limited. Patients’ interest in using this information when selecting a hospital for cancer surgery and the specific data they would desire are unknown. This study gauges patients’ demand for comparative information on hospitals’ quality of cancer surgery. Methods: We conducted a cross-sectional, national survey of 3,334 US residents who had received cancer surgery. The outcomes were patients’ reported likelihood of using a list of best hospitals for cancer surgery and patients’ reported interest in information about specific clinical outcomes, including 4-year survival after surgery, 30-day mortality after surgery, and rate of complications from surgery. Results: Two thirds of patients (68%) reported being actively involved in selecting a hospital for their surgery, and two thirds (65%) reported that their physician was involved in or made this decision. When asked what information might have helped them to choose a hospital, participants identified the hospital’s reputation (55%), patient satisfaction (44%), and the number of cancer surgeries performed at the hospital (36%). Approximately three quarters (73%) reported being likely to use a list of best hospitals for cancer surgery when selecting a hospital. Approximately 40% expressed interest in having information on at least one clinical outcome. Conclusion: Widespread interest exists among patients with cancer for comparative information on hospital quality as well as on clinical outcomes and hospitals’ reputation for cancer surgery. Policy reforms and additional research should address the unmet need for transparent, comprehensive data on the quality of hospitals’ cancer care.
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Shariff-Marco, Salma, Libby Ellis, Juan Yang, Jocelyn Koo, Esther M. John, Theresa H. M. Keegan, Iona Cheng, et al. "Hospital Characteristics and Breast Cancer Survival in the California Breast Cancer Survivorship Consortium." JCO Oncology Practice 16, no. 6 (June 2020): e517-e528. http://dx.doi.org/10.1200/op.20.00064.
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INTRODUCTION: Racial/ethnic disparities in breast cancer survival are well documented, but the influence of health care institutions is unclear. We therefore examined the effect of hospital characteristics on survival. METHODS: Harmonized data pooled from 5 case-control and prospective cohort studies within the California Breast Cancer Survivorship Consortium were linked to the California Cancer Registry and the California Neighborhoods Data System. The study included 9,701 patients with breast cancer who were diagnosed between 1993 and 2007. First reporting hospitals were classified by hospital type—National Cancer Institute (NCI) –designated cancer center, American College of Surgeons (ACS) Cancer Program, other—and hospital composition of the neighborhood socioeconomic status and race/ethnicity of patients with cancer. Multivariable Cox proportional hazards models adjusted for clinical and patient-level prognostic factors were used to examine the influence of hospital characteristics on survival. RESULTS: Fewer than one half of women received their initial care at an NCI-designated cancer center (5%) or ACS program (38%) hospital. Receipt of initial care in ACS program hospitals varied by race/ethnicity—highest among non-Latina White patients (45%), and lowest among African Americans (21%). African-American women had superior breast cancer survival when receiving initial care in ACS hospitals versus other hospitals (non-ACS program and non–NCI-designated cancer center; hazard ratio, 0.67; 95% CI, 0.55 to 0.83). Other hospital characteristics were not associated with survival. CONCLUSION: African American women may benefit significantly from breast cancer care in ACS program hospitals; however, most did not receive initial care at such facilities. Future research should identify the aspects of ACS program hospitals that are associated with higher survival and evaluate strategies by which to enhance access to and use of high-quality hospitals, particularly among African American women.
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Bilimoria, Karl Y., David J. Bentrem, Andrew K. Stewart, David P. Winchester, and Clifford Y. Ko. "Comparison of Commission on Cancer–Approved and –Nonapproved Hospitals in the United States: Implications for Studies That Use the National Cancer Data Base." Journal of Clinical Oncology 27, no. 25 (September 1, 2009): 4177–81. http://dx.doi.org/10.1200/jco.2008.21.7018.
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Background The Commission on Cancer (CoC) designates cancer programs on the basis of the ability to provide a wide range of oncologic services and specialists. All CoC-approved hospitals are required to report their cancer diagnoses to the National Cancer Data Base (NCDB), and the cancer diagnoses at these hospitals account for approximately 70% of all new cancers diagnosed in the United States annually. However, it is unknown how CoC-approved programs compare with non–CoC-approved hospitals. Methods By using the American Hospital Association Annual Survey Database (2006), CoC-approved and non–CoC-approved hospitals were compared with respect to structural characteristics (ie, accreditations, geography, and oncologic services provided). Results Of the 4,850 hospitals identified, 1,412 (29%) were CoC-approved hospitals, and 3,438 (71%) were not CoC-approved hospitals. The proportion of CoC-approved hospitals varied at the state level from 0% in Wyoming to 100% in Delaware. Compared with non–CoC-approved hospitals, CoC-approved programs were more frequently accredited by the Joint Commission, designated as a Comprehensive Cancer Center by the National Cancer Institute, and affiliated with a medical school or residency program (P < .001). CoC-approved hospitals were less likely to be critical access hospitals or located in rural areas (P < .001). CoC-approved hospitals had more total beds and performed more operations per year (P < .001). CoC-approved programs more frequently offered oncology-related services, including screening programs, chemotherapy and radiation therapy services, and hospice/palliative care (P < .001). Conclusion Compared with non–CoC-approved hospitals, CoC-approved hospitals were larger, were more frequently located in urban locations, and had more cancer-related services available to patients. Studies that use the NCDB should acknowledge this limitation when relevant.
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Shulman, Lawrence N., Bryan E. Palis, Ryan McCabe, Kathy Mallin, Ashley Loomis, David Winchester, and Daniel McKellar. "Survival As a Quality Metric of Cancer Care: Use of the National Cancer Data Base to Assess Hospital Performance." Journal of Oncology Practice 14, no. 1 (January 2018): e59-e72. http://dx.doi.org/10.1200/jop.2016.020446.
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Purpose: Survival is considered an important indicator of the quality of cancer care, but the validity of different methodologies to measure comparative survival rates is less well understood. We explored whether the National Cancer Data Base (NCDB) could serve as a source of unadjusted and risk-adjusted cancer survival data and whether these data could be used as quality indicators for individual hospitals or in the aggregate by hospital type. Methods: The NCDB, an aggregate of > 1,500 hospital cancer registries, was queried to analyze unadjusted and risk-adjusted hazards of death for patients with stage III breast cancer (n = 116,787) and stage IIIB or IV non–small-cell lung cancer (n = 252,392). Data were analyzed at the individual hospital level and by hospital type. Results: At the hospital level, after risk adjustment, few hospitals had comparative risk-adjusted survival rates that were statistically better or worse. By hospital type, National Cancer Institute–designated comprehensive cancer centers had risk-adjusted survival ratios that were statistically significantly better than those of academic cancer centers and community hospitals. Conclusion: Using the NCDB as the data source, survival rates for patients with stage III breast cancer and stage IIIB or IV non–small-cell lung cancer were statistically better at National Cancer Institute–designated comprehensive cancer centers when compared with other hospital types. Compared with academic hospitals, risk-adjusted survival was lower in community hospitals. At the individual hospital level, after risk adjustment, few hospitals were shown to have statistically better or worse survival, suggesting that, using NCDB data, survival may not be a good metric to determine relative quality of cancer care at this level.
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Ferry, Elizabeth Kate, and Hui Zhu. "Surgical management trends of penile cancer in the United States between 2000 and 2010." Journal of Clinical Oncology 32, no. 4_suppl (February 1, 2014): 379. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.379.
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379 Background: Penile cancer may cause significant morbidities to those who are treated with aggressive surgery. Conversely, there has been no improvement in penile cancer survival rates since 1990. While the causes for this stagnation may be multifactorial, one potential cause is undertreatment of high-risk disease. This study aimed to examine both the trend in the stage-dependent surgical treatment for penile cancer from 2000 to 2010 and the patterns of possible over and/or undertreatment during this period. Methods: The National Cancer Database (NCDB) Datalinks Portal was queried. Diagnosis by year, first course surgery by stage, in all hospitals from 2000-2010 was first obtained. Data was grouped into no surgery, penile sparing, and radical surgery. Data was also obtained for first course surgery by stage in community hospitals (C), comprehensive centers (CC), and teaching research hospitals (TR), individually. Groups were similar as above, with the exclusion of the no surgery group. Results: There were 1,405 patients with recorded first course surgical treatments in community hospitals, 3,930 in comprehensive hospitals, and 3,667 in teaching research hospitals from 2000 to 2010. Graphically, there has been no change in the trend in the pattern of surgical management of penile cancer from 2000 to 2010 in high or low stage penile cancers. Consistent overtreatment of stage I penile cancer with radical surgery was observed in all hospitals during this period. A variable, but high, percentage of penile-sparing surgery was observed for advanced stages among all hospital types. Conclusions: Corresponding to the stagnation in the survival rates of penile cancer, the surgical management trends ded not change between 2000 and 2010. Contrary to the 2013 National Comprehensive Cancer Network (NCCN) Guidelines, penile-sparing surgery continues to be performed in all types of treating hospitals for higher stage penile cancers, which may represent an undertreatment of potentially fatal penile cancers. Conversely, there was a persistent pattern of overtreatment of stage I penile cancer. [Table: see text]
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Okuyama, Ayako, Yukie Takemura, and Takahiro Higashi. "Identifying cancer patients’ care needs after discharge hospital using health claim data linked with Hospital-based Cancer Registry data in Japan." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18012-e18012. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18012.
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e18012 Background: In 2018, the 3rd Cancer Control Plan developed in Japan. This plan recommends that we should create a better society for cancer patients to keep living at their homes after leaving hospital. In order to grasp the continuous health care needs, we investigated independence degree of Activities of Daily Living (ADL) at the time of discharge for cancer patients by hospital types. Methods: We analyzed the health insurance claims database linked with the hospital-based cancer registry of 230 cancer care hospitals covered the period from October 2012 to December 2014. Data were abstracted from patients who 1) were diagnosed with breast, lung, liver, colorectal, stomach, pancreas, or prostate cancer in 2013; 2) were 20 years or older at the time of the diagnosis; and 3) received the first course or continuous treatment at the hospital. Ministry of Health, Labor and Welfare designates cancer care hospitals (DCCHs) to provide a high quality of cancer care. In each prefecture, one hospital is designated as Type 1 DCCH, and it has the role of supporting other DCCHs in that prefecture. Remaining DCCHs are Type 2 DCCHs. Hospitals which are not designated as DCCHs are categorized into other hospitals. We assessed the differences of patient’ ADL status by these hospital types. Results: We extracted 37,523 patients’ discharge data (8,271 from Type 1 DCCHs, 28,200 from Type 2 DCCHs, and 1,052 from other hospitals). The mean age (SD) at the time of diagnosis was 65.6 (11.7) at Type 1 DCCHs, 69.1 (11.0) at Type 2 DCCHs, and 70.0 (12.3) at other hospitals. The percentage of clinical stage IV in other hospitals (25.3%) was slightly higher than others (22.5%). In total, 16.2% of patients need all assistance for bathing, while only 3.5% of patients need all assistance for eating. More patients at other hospitals were need assistance for ADL compared to patients at DCCHs. For example, 10.6% of patients need all assistance for bathing in type 1 DCCHs, while 25.2% of patients need it in other hospitals. Conclusions: Many patients discharged in not DCCHs need more assistance for their daily living. We should take these situation into account when we provide appropriate support for cancer patients.
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Clarke, Christina A., Laurence C. Baker, Jennifer Malin, Joseph Parker, Merry Holliday-Hanson, Niya Fong, Stephanie Teleki, Lance Lang, and Maryann O'Sullivan. "Creating an online resource providing hospital cancer surgery volumes in California." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 172. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.172.
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172 Background: Little evidence is available to help patients and providers, payers and policymakers find the highest-quality hospitals for cancer surgery. We initiated a groundbreaking effort in California ( www.calqualitycare.org ) to publicly report hospital cancer surgery volume data online. Methods: With financial support from the nonprofit California HealthCare Foundation, we assembled a multidisciplinary team to oversee the project and ensure sound methodology. We obtained existing hospital discharge summary data from the California Office of Statewide Health Planning and Development (OSHPD). We selected cancer surgeries eligible for display through comprehensive review of the literature addressing the association of hospital volume and mortality. We found eleven cancer sites with sufficient evidence of association including bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach. Experts advised volume calculation and display of results. Leaders of low volume hospitals were interviewed to understand the reasons for low volume. Results: In 2014, about 60% of cancer surgeries in California were performed at hospitals in the top 20% of volume, but many hospitals performed low numbers of complex procedures, with the per hospital median number of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries at 4 or less. Low-volume hospitals included rural and urban hospitals, with small and large bed sizes, and teaching and non-teaching status. At least 670 Californians received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer site; 72% of those patients lived within 50 miles of a top-20% volume hospital. Conclusions: This project demonstrates the potential for public information about hospital volumes to point patients towards high-volume and away from low-volume hospitals. Data regarding 2014 volumes are now available online.
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Lipitz-Snyderman, Allison, Jessica A. Lavery, Peter Bach, Diane G. Li, Annie Yang, Vivian E. Strong, Ashley Russo, and Katherine Panageas. "Opportunity for performance measurement: 30-day mortality following cancer surgeries across U.S. hospitals." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18221-e18221. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18221.
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e18221 Background: While public reporting of surgical outcomes for non-cancer conditions is common, measures of outcomes following surgery for cancer have generally been excluded. This is true even though numerous studies show large variations between hospitals. We assessed whether prerequisites for quality reporting are present for the measure of 30-day cancer surgical mortality: low burden for timely reporting, hospital variation, and potential for public health gains. Methods: We used Fee-for-Service (FFS) Medicare claims to examine the extent of variation in 30-day mortality between 3,860 U.S. hospitals performing cancer surgery for patients ≥66 years, 2011-2013. Hierarchical mixed-effects logistic regression models adjusted for patient and hospital characteristics and with a random hospital effect were fit to obtain hospital-specific risk-standardized mortality rates (RSMRs) and 99% confidence intervals (CI). From these models we calculated a hospital odds ratio to describe the difference in the mortality risk for a hospital above versus below average quality and estimated the potential reduction in mortality under a scenario of improved quality for the lowest performers. Outcomes included extent of hospital variability in 30-day mortality after cancer surgery; and impact on lives saved from improving performance at outlier hospitals. Results: Over the three-year observation period, the median number of cancer surgeries performed per hospital was 34. For individual cancer sites, it was < 10, except for breast (median 17) and colorectal (median 14). The median RSMR overall was 2.41% (99% CI 2.28%, 2.66%). Breast had the lowest RSMR (median 0.24%) and gastroesophageal the highest (median 5.72%). In aggregate and for most individual cancers, variation between hospitals exceeded that due to differences in patient and hospital characteristics, and was robust to excluding emergent cases. For individual cancer sites, relative differences exceeded 20% in the risk of 30-day mortality between patients undergoing surgery at a hospital below average quality versus above average quality, with the potential for an estimated 500 deaths prevented annually given hypothetical improvements. Conclusions: Quality measurement and reporting of 30-day mortality for cancer surgery is worthy of consideration.
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Balanda, Kevin P., John B. Lowe, Warren Stanton, Amaya Gillespie, and Vincent Conway. "Cancer Control Activities in Australian Public Hospitals." International Quarterly of Community Health Education 15, no. 3 (October 1994): 229–40. http://dx.doi.org/10.2190/gxjq-gp33-pmx9-7nlh.
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Cancer is a major cause of death in Australia and there is considerable interest in the role health education in hospital settings has in reducing this burden. Based on a survey of medical superintendents and other hospital staff, this article describes the cancer control activities routinely conducted in Australian public hospitals. The survey considered cigarette smoking, alcohol, diet and nutrition, exercise, and the early detection of skin cancer, cervical cancer, and breast cancer. Overall 112 medical superintendents (93%) participated and a further 163 hospital staff members provided additional details. Not unexpectedly, the survey confirmed the very low level of activity and identified a number of specific issues that need to be addressed in order to enhance cancer control activities in public hospitals. Given the relatively higher level of activity, and the prominence of cigarette smoking and alcohol consumption as health issues, one approach might be to initially concentrate on these areas when they are related to the patient's condition.
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Bickell, Nina A., Jenny J. Lin, Rebeca Franco, and Natalia Egorova. "Breast cancer: Does where you get treated affect survival?" Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): 28. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.28.
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28 Background: Under the ACA, more women are insured with Medicaid which should improve access to cancer care. However, Disproportionate Share Hospitals (DSH) are due to receive reduced subsidies thereby threatening resource stressed facilities and poorer hospitals are experiencing greater financial penalties due to higher readmission rates. In NYS, 83% of Medicaid breast cancer patients got their cancer surgery at DSH hospitals. As women gain more choice and access, they will require information about hospitals’ quality and outcomes of cancer care. We sought to determine whether there are survival advantages among breast cancer patients treated at hospitals with varying proportions of Medicaid patients. Methods: We used non-obstetric delivery Medicaid discharges from NYS hospitals in 2005-13 to create quintiles of hospitalized patients with Medicaid. Women treated for breast cancer were identified with a diagnostic and procedure code for breast cancer. Based on NYS hospital discharge database linked with vital statistics death records, we calculated hazard ratios using marginal Cox model with a robust sandwich variance estimator controlling for clustering of patients within the hospital, age and comorbidity. Results: Quintiles of Medicaid hospitals ranged from low (0-15%), to low medium (15-22%), medium (22-29%), medium-high (29-50%), to high ( > 50%). 26% of breast cancer patients were treated at the low; 22% at the low medium; 20% at the medium; 21% at the medium-high and 11% at high quintile hospitals. Patients treated in hospitals with > 50% Medicaid patients had a higher long-term mortality (HR = 1.51; 95%CI: 1.19-1.93) compared to those treated at the lowest quintile hospitals. Sensitivity analyses to adjust for stage are underway. Conclusions: While the ACA may improve access to breast cancer treatment, the long term impact on survival remains questionable as women with breast cancer treated at hospitals with high proportions of Medicaid patients may have worse survival. Analyses to control for stage are underway. Pending these results, hospitals with high proportions of Medicaid patients may need to target cancer quality improvement efforts to assure equitable outcomes.
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Lyimo, Emanuel P., Susan F. Rumisha, Irene R. Mremi, Chacha D. Mangu, Coleman Kishamawe, Mercy G. Chiduo, Lucas E. Matemba, Veneranda M. Bwana, Isolide S. Massawe, and Leonard E. G. Mboera. "Cancer Mortality Patterns in Tanzania: A Retrospective Hospital-Based Study, 2006-2015." JCO Global Oncology, no. 6 (September 2020): 224–32. http://dx.doi.org/10.1200/jgo.19.00270.
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PURPOSE This retrospective study sought to determine the type, burden, and pattern of cancer deaths in public hospitals in Tanzania from 2006 to 2015. METHODS This study analyzed data on cancer mortality in 39 hospitals in Tanzania. Data on the age and sex of the deceased and type of cancer were extracted from hospital death registers and report forms. Cancer types were grouped according to the 10th revision of the International Classification of Diseases. Age-standardized mortality rates and cancer mortality patterns were analyzed. A χ2 test was used to examine the association between common cancers and selected covariates. RESULTS A total of 12,621 cancer-related deaths occurred during the 10-year period, which translates to an age-standardized hospital-based mortality rate of 47.8 per 100,000 population. Overall, the number of deaths was notably higher (56.5%) among individuals in the 15- to 59-year-old age category and disproportionately higher among females than males ( P = .0017). Cancers of the cervix, esophagus, and liver were the 3 major causes of death across all study hospitals in Tanzania. Cancers of the cervix, esophagus, and liver were the largest contributors to mortality burden among females. Among males, cancers of the esophagus, liver, and prostate were the leading cause of mortality. CONCLUSION There is an increasing trend in cancer mortality over recent years in Tanzania, which differs with respect to age, sex, and geographic zones. These findings provide a basis for additional studies to ascertain incidence rates and survival probabilities, and highlight the need to strengthen awareness campaigns for early detection, access to care, and improved diagnostic capabilities.
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Pradhananga, K. K. "Cancer Incidence in 12 Major Hospitals of Nepal." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 126s. http://dx.doi.org/10.1200/jgo.18.97000.
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Background and context: In Nepal, no population based cancer registry program exists to know the incidence, prevalence, morbidity and mortality of cancer. Since 2003 AD we have been conducting hospital based cancer registry program in 7 major hospitals and now we include 12 hospitals in 2014 in the initiation of BP Koirala Memorial Cancer Hospital. Aim: To find out about the burden across a greater proportion of cancer from 12 major hospitals of Nepal. Strategy/Tactics: Coordination with 12 hospitals´ medical record section to abstract the cancer data. The cases were verified by name, age, sex, address, topography and morphology. Repeated cancer cases were excluded from database. Program/Policy process: The total 9036 cancer cases were included in this study to know the cancer incidence in 12 major hospitals in 2014. This was descriptive type of study and all cases were collected from medical record section for data analysis. Outcomes: Among case the mean age of the patients was 53.6 years. The common form of cancer for both sex was bronchus and lung (13.7%) followed by cervix uteri (9.4%) and breast (9.4%). Cancer of the cervix (17.0%) was the top ranking cancer site for female followed by breast (16.4%) and bronchus and lung (10.9%). Similarly, cancer of the bronchus and lung (17.2%) was the commonest cancer for male followed by stomach (7.6%) and larynx (6.2%). Female cases (54.0%) were frequently high than in male (46.0%). What was learned: This type of study shows burden across a greater proportion of cancer from 12 major hospitals, but the coverage may not represent the whole country.
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Fang, Juemin, Xianling Guo, Zhongzheng Zhu, Hui Wang, Fei Hu, Jianhua Chen, Song Gao, et al. "Watson for Oncology applied to teaching and remote consulting model." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 6545. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6545.
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6545 Background: IBM Watson for Oncology (WFO) is developed with artificial intelligence to assist the oncologists in treatment decision-making by providing evidence-based treatment recommendations with priority and personality. We have been exploring the value of applying WFO in teaching and remote consulting among members in the hospital union to improve medical quality and conformity. Methods: Four modes were followed to apply WFO to teaching and remote consulting. Firstly, a teaching hospital conducted instructional teaching for a primary hospital through WFO, or a primary hospital consulted with a teaching hospital on cancer treatment combined with WFO. Secondly, a teaching hospital conducted conference-based teaching and remote consulting for two or three primary hospitals through demonstrating WFO. Thirdly, we cooperated with other teaching hospitals to carry out interactive discussions on cases through WFO with several primary hospitals. Fourthly, we cooperated with other teaching hospitals to conduct WFO demonstration and discussion for several primary hospitals. Remote communication was performed by using third-party video conference software. A survey was conducted to collect feedback from 56 primary hospitals in our hospital union. Results: More than 80% of primary hospitals were willing to learn the standardized treatment and recent treatment progress of tumors by participating in WFO remote consulting in our hospital. The value of four modes to promote the standardized cancer treatment and improve the medical quality and conformity in primary hospitals were all recognized. WFO also contributed to academic exchanges and learning among high-level teaching hospitals, and facilitated the use of artificial intelligence in oncology therapy more rational and appropriate. Conclusions: Non-standardization in cancer care remains to be a big problem in primary hospitals in China. Although limitation of WFO exists in the complex cases of certain tumor types, the rational use of WFO in the teaching and remote consulting could help and promote the standardized cancer treatment in China.
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Maurice, Matthew J., Robert Abouassaly, and Hui Zhu. "American trends in expectant management utilization for prostate cancer from 2000 to 2009." Canadian Urological Association Journal 8, no. 11-12 (November 24, 2014): 775. http://dx.doi.org/10.5489/cuaj.2073.
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Introduction: The overtreatment of early prostate cancer has become a major public health concern. Expectant management (EM) is a strategy to minimize overtreatment, but little is known about its pattern of use. We sought to examine national EM utilization over the preceding decade.Methods: We examined prostate cancer treatment utilization from 2000 to 2009 using the National Cancer Database. EM use was analyzed in relation to other treatments and by cancer stage, age group, Charlson score, and hospital practice setting.Results: Overall, 109 997 (8.2%) men were managed initially with EM. EM usage remained stable at 7.6% to 9.5% from 2000 to 2009 with no appreciable increase for low-stage cancers. Usage was only slightly higher in elderly patients and in patients with multiple comorbidities. Veterans Affairs and low-volume hospitals had a much higher and increasing EM rate (range: 18.8%-29.8% and 15.1%-24.2%, respectively), compared to community hospitals, comprehensive cancer centres, and teaching hospitals, which showed no increased adoption. On further analysis, EM use remained high for low-stage cancers at Veterans Affairs and low-volume hospitals (24.0% and 19.1%, respectively), regardless of age or comorbidity, a pattern not shared by other practice settings.Conclusions: EM utilization remained low and stable last decade, regardless of disease or patient characteristics. Conversely, Veterans Affairs and low-volume hospitals led the trend in national EM adoption, particularly in men with low-stage cancers and limited life expectancies. The limitations of this dataset preclude any determination of the appropriateness of EM utilization. Nonetheless, further study is needed to identify factors influencing EM adoption to ensure its proper use in the future.
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Muñoz, Laura, Elisa Puigdomènech, Xavier Garcia Cuscó, César Velasco, and Mireia Espallargues. "PP284 Volume-Result Relationship Analysis In Digestive Oncological Surgery In Spain By Using Health Data Records." International Journal of Technology Assessment in Health Care 36, S1 (December 2020): 24–25. http://dx.doi.org/10.1017/s026646232000149x.
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IntroductionIn order to improve patients’ health outcomes, it is important to know the available evidence regarding centralization of surgical interventions for digestive cancer in hospitals with the highest volume of cases. We aim to describe and identify the number of annual interventions recommended by hospitals in order to maximize the health outcomes and efficiency for patients undergoing digestive cancer surgery during 2013–2016 in centers belonging to the Spanish National Health System (SNS).MethodsThe study design was a retrospective cohort study (patients aged ≥18 years). Data from Spanish public hospitals’ basic minimum set of data at hospital discharge for esophagus, stomach, liver, pancreas and rectum cancers was used. Age, sex primary/secondary diagnosis and procedures (Charlson index) were included. Reinterventions, hospital stay and in-hospital mortality were considered as the outcomes and measures of efficiency. Hospitals were grouped as low-/medium-/high-volume according to the number of annual procedures. Descriptive analysis and logistic and Poisson regression models with Stata16 were undertaken.ResultsHigh-volume hospitals performed between 67.4 (rectum) and 88.6 (liver) percent of interventions. The percentage of in-hospital mortality for all cancers was lower in high-volume centers (9.6% esophagus, 6.6% stomach, 7.1% pancreas, 4.2% liver and 2.2% rectum), showing a negative association between center volume and in-hospital mortality, which was statistically significant for esophagus (odds ratio [OR] = 0.48; 95% confidence interval [CI]: 0.28–0.81), stomach (OR = 0.51; 95% CI: 0.39–0.68) and rectum (OR = 0.63; 95% CI: 0.48–0.83) cancers. A non-statistically significant lower in hospital stay was observed in high-volume hospitals.ConclusionsThese results indicate that in Spain there is a negative association between the number of digestive oncological interventions per hospital and in-hospital mortality. This could help to define a threshold or cut-off point for the concentration of digestive cancer surgery in the SNS that might result in an improvement of lower in-hospital mortality and/or hospital stay.
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Voeten, Daan M., Leonie R. van der Werf, Janneke A. Wilschut, Linde A. D. Busweiler, Johanna W. van Sandick, Richard van Hillegersberg, and Mark I. van Berge Henegouwen. "Failure to Cure in Patients Undergoing Surgery for Gastric Cancer: A Nationwide Cohort Study." Annals of Surgical Oncology 28, no. 8 (January 23, 2021): 4484–96. http://dx.doi.org/10.1245/s10434-020-09510-6.
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Abstract Background This study aimed to describe the incidence of failure to cure (a composite outcome measure defined as surgery not meeting its initial aim), and the impact of hospital variation in the administration of neoadjuvant therapy on this outcome measure. Methods All patients in the Dutch Upper Gastrointestinal Cancer Audit undergoing curatively intended gastric cancer surgery in 2011–2019 were included. Failure to cure was defined as (1) ‘open-close’ surgery; (2) irradical surgery (R1/R2); or (3) 30-day/in-hospital mortality. Case-mix-corrected funnel plots, based on multivariable logistic regression analyses, investigated hospital variation. The impact of a hospital’s tendency to administer neoadjuvant chemotherapy on the heterogeneity in failure to cure between hospitals was assessed based on median odds ratios and multilevel logistic regression analyses. Results Some 3862 patients from 28 hospitals were included. Failure to cure was noted in 22.3% (hospital variation: 14.5–34.8%). After case-mix correction, two hospitals had significantly higher-than-expected failure to cure rates, and one hospital had a lower-than-expected rate. The failure to cure rate was significantly higher in hospitals with a low tendency to administer neoadjuvant chemotherapy. Approximately 29% of hospital variation in failure to cure could be attributed to different hospital policies regarding neoadjuvant therapy. Conclusions Failure to cure has an incidence of 22% in patients undergoing gastric cancer surgery. Higher failure to cure rates were seen in centers administering less neoadjuvant chemotherapy, which confirms the Dutch guideline recommendation on the administration of neoadjuvant chemotherapy. Failure to cure provides short loop feedback and can be used as a quality indicator in surgical audits.
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Liu, Jason B., Karl Y. Bilimoria, Katherine Mallin, Clifford Y. Ko, and David P. Winchester. "Why do patients still go to low-volume hospitals for complex cancer surgery?" Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 300. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.300.
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300 Background: While a strong volume-outcome relationship exists for many cancer operations, patients continue to undergo these operations at low-volume centers. Methods: Patients were identified from the National Cancer Data Base (NCDB) from 2010-2014 who underwent resection for bladder, breast, esophagus, stomach, pancreas, lung and rectal malignancies from 1,406 hospitals. Low-volume hospitals were defined as those in the bottom quartile by surgical volume for each operation separately. Regression models were developed to assess patient-level factors associated with undergoing surgery at a low-volume hospital for their malignancy. Results: Of 633,853 patients identified, 49,926 (7.9%) underwent cancer surgery at a low-volume hospital. The low-volume threshold was 1 case/year for bladder, 34 for breast, 1 for esophagus, 1 for stomach, 1 for pancreas, 5 for lung, and 2 for rectal cancers. For all the cancer surgeries examined, patients were more likely to undergo surgery at a low-volume hospital if they lived in a rural area or if they already had to drive a long distance just to reach the low-volume hospital. Patient demographics, socioeconomic factors, insurance type, comorbidities, and stage of disease were not consistently associated with undergoing surgery at a low-volume hospital across all malignancies. Although breast cancer is a common cancer with a less established volume-outcome relationship, the factors associated with undergoing surgery at a low-volume hospital were similar to those of the more complex cancer operations. Conclusions: Patients continue to undergo surgery at low-volume hospitals due to where they live and how far they have to travel. Regionalization policy initiatives will remain challenging in this population. Efforts should therefore continue to emphasize quality improvement locally at each facility caring for patients with cancer.
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Aquina, Christopher Thomas, Adan Z. Becerra, Aslam Ejaz, John R. T. Monson, and Fergal J. Fleming. "Comprehensive or specialty-specific cancer care in the United States: A story of continuing underperformance." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 6577. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.6577.
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6577 Background: “Textbook oncologic outcome” (TOO) is a composite measure representing the “ideal” outcome for patients undergoing cancer surgery and is associated with improved survival. Using TOO as the primary outcome, we asked whether hospitals are high-performing across multiple cancer types. Methods: Patients undergoing potentially curative breast, colon, rectal, lung, or pancreatic cancer resection were identified within the National Cancer Database (2010-2016). Organ-specific TOO was defined as: adequate lymph node yield, R0 resection, non-length of stay outlier, no hospital readmission, no 90-day postoperative mortality, and receipt of guideline-concordant chemotherapy and/or radiation. Mixed-effects analyses estimated the risk-adjusted TOO rate for each hospital stratified by cancer type. Results: Among 1,094,550 cancer resections (breast = 690,442; colon = 213,918; lung = 121,771; rectum = 40,315; pancreas = 28,104), 434 hospitals performed ≥10 resections for each cancer type. Only 11 hospitals (2.5%) ranked in the top quartile for adjusted TOO rate for all five cancer types. Of the 323 hospitals (74.4%) that ranked in the top quartile for one cancer type, 149 hospitals (46.1%) also ranked in the bottom quartile for another cancer type. There was a weak correlation between hospital rankings across cancer types with the strongest correlations between colon and rectal cancer (R2= 0.148) and lung and pancreatic cancer (R2= 0.098). Conclusions: Most U.S. hospitals do not provide high-quality care across cancer types with respect to TOO. Perhaps this knowledge should be used to guide referral for oncology care.
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Seagle, Brandon-Luke L., Anna E. Strohl, Monica Dandapani, Wilberto Nieves-Neira, and Shohreh Shahabi. "Survival Disparities by Hospital Volume Among American Women With Gynecologic Cancers." JCO Clinical Cancer Informatics, no. 1 (November 2017): 1–15. http://dx.doi.org/10.1200/cci.16.00053.
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Purpose We describe survival disparities among women with uterine, ovarian, or cervical cancer by cancer-specific mean annual hospital volume. Methods National Cancer Database 1998-2011 uterine (n = 441,863), ovarian (n = 223,017), and cervical (n = 146,698) cancer data sets were used. Cancer-specific mean annual hospital volumes were calculated. Overall survival (OS) was plotted by hospital volume using restricted mean OS times from Cox regression. Results Uterine, ovarian, and cervical cancers were reported from 1,651, 1,633, and 1,600 hospitals, respectively. Median values of mean annual hospital volumes among hospitals were 8.6 (interquartile range [IQR], 2.6 to 20.8), 4.4 (IQR, 1.4 to 10.3), and 2.4 (IQR, 0.6 to 6.6) for uterine, ovarian, and cervical cancers, respectively. Increased hospital volume was associated with increased OS among women with stage III to IV high-grade serous ovarian cancer, stage II to IV squamous or adenocarcinoma cervical cancer, and stage I to IV endometrioid, clear cell, serous, or carcinosarcoma uterine cancers (all P < .03). Differential OS between women treated at higher- versus lower-volume cancer centers exceeded 5, 5, and 13 months among women with advanced endometrial, ovarian, or cervical cancer, respectively (all P < .001). Hospital volume was not associated with OS among patients with stage II to IV cervical cancer treated with brachytherapy ( P = .17). Use of adjuvant therapies decreased OS disparities by hospital volume among women with advanced ovarian or endometrial cancer. Conclusion Increased delivery of brachytherapy for treatment of cervical cancer may decrease survival disparities by hospital volume. Standardization of adjuvant therapies may diminish survival disparities by hospital volume among women with advanced ovarian or endometrial cancer. In addition, survival of American women with gynecologic cancer may be increased by centralization of care.
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Megwalu, Uchechukwu C., Yifei Ma, Tina Hernandez-Boussard, Vasu Divi, and Scarlett Lin Gomez. "The Impact of Hospital Quality on Thyroid Cancer Survival." Otolaryngology–Head and Neck Surgery 162, no. 3 (January 21, 2020): 269–76. http://dx.doi.org/10.1177/0194599819900760.
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Objective To develop a composite measure of thyroid cancer–specific hospital quality and to evaluate the association between hospital quality and survival in patients with well-differentiated thyroid cancer. Study Design Retrospective cohort study. Setting Population-based cancer database. Subjects and Methods Data were extracted from the California Cancer Registry data set linked with discharge records and hospital characteristics from the California Office of Statewide Health Planning and Development. The study cohort comprised adult patients with well-differentiated thyroid cancer diagnosed between January 1, 2004, and December 31, 2015. Principal component analysis, incorporating hospital volume, adherence to national guidelines, and accreditation/certification status, was used to generate a composite thyroid cancer–specific hospital quality score. Results Treatment in hospitals ranked in the highest quartile of quality was associated with improved overall survival (OS) (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.67-0.98) and disease-specific survival (DSS) (HR, 0.72; 95% CI, 0.54-0.98). Treatment in hospitals meeting the combined metric of 10 or more thyroid cancer cases/year and 80% of patients with high-risk tumors treated with total/near-total thyroidectomy was associated with improved OS (HR, 0.80; 95% CI, 0.70-0.90) and DSS (HR, 0.77; 95% CI, 0.64-0.94). Conclusion Treatment in high-quality hospitals is associated with improved survival outcomes in patients with thyroid cancer. These findings are important because they help identify hospitals that are better suited to treat patients with thyroid cancer and provide actionable targets for quality improvement.
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Abel, Gary A., Mayam Gomez-Cano, Tra My Pham, and Georgios Lyratzopoulos. "Reliability of hospital scores for the Cancer Patient Experience Survey: analysis of publicly reported patient survey data." BMJ Open 9, no. 7 (July 2019): e029037. http://dx.doi.org/10.1136/bmjopen-2019-029037.
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ObjectivesTo assess the degree to which variations in publicly reported hospital scores arising from the English Cancer Patient Experience Survey (CPES) are subject to chance.DesignSecondary analysis of publically reported data.SettingEnglish National Health Service hospitals.Participants72 756 patients who were recently treated for cancer in one of 146 hospitals and responded to the 2016 English CPES.Main outcome measuresSpearman-Brown reliability of hospital scores on 51 evaluative questions regarding cancer care.ResultsHospitals varied in respondent sample size with a median hospital sample size of 419 responses (range 31–1972). There were some hospitals with generally highly reliable scores across most questions, whereas other hospitals had generally unreliable scores (the median reliability of question scores within individual hospitals varied between 0.11 and 0.86). Similarly, there were some questions with generally high reliability across most hospitals, whereas other questions had generally low reliability. Of the 7377 individual hospital scores publically reported (146 hospitals by 51 questions, minus 69 suppressed scores), only 34% reached a reliability of 0.7, the minimum generally considered to be useful. In order for 80% of the individual hospital scores to reach a reliability of 0.7, some hospitals would require a fourfold increase in number of respondents; although in a few other hospitals sample sizes could be reduced.ConclusionsThe English Patient Experience Survey represents a globally unique source for understanding experience of a patient with cancer; but in its present form, it is not reliable for high stakes comparisons of the performance of different hospitals. Revised sampling strategies and survey questions could help increase the reliability of hospital scores, and thus make the survey fit for use in performance comparisons.
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Singla, Abhishek, Avyakta Kallam, Jayanth Adusumalli, Mahmoud Abu Hazeem, and Peter T. Silberstein. "Disparities in first-course treatment of non-small cell lung cancer among different hospital types in the United States." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6568. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6568.
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6568 Background: Treatment of non-small cell lung cancer (NSCLC) involves surgery, chemotherapy and radiation therapy in various combinations depending upon stage. This study compares disparities in the 1st course treatment given to NSCLC patients amongst different hospital types. Methods: We analyzed National Cancer Data Base for differences in 1st course treatment received for NSCLC amongst 3 hospital categories- Community hospitals (facilities which diagnose and/or treat 100-649 cancer cases annually), Comprehensive Community Hospitals (facilities which diagnose and/or treat 650 or more) and Teaching/Research Hospitals (facilities associated with university medical schools or designated as Comprehensive Cancer Care Programs by National Cancer Institute). Chi square test was used for statistical analysis. Results: 975,229 patients with NSCLC received treatment in 1,399 U.S. hospitals between 2000 and 2010. 71%, 81% and 84% of patients presenting to Community, Comprehensive and Teaching/Research hospitals received 1st course treatment at those centers. Surgery was done in 64%, 77% and 81% of stage I; 52%, 62% and 71% of stage II and 16%, 20% and 27% of stage III patients treated by Community, Comprehensive and Teaching/Research hospitals respectively (p<0.001 for all comparisons) (Table). Also, chemotherapy was given as a part of 1st course treatment in 37%, 30% and 22% of stage II patients treated by these hospitals respectively (p<0.001 for all comparisons). Conclusions: Significant disparities exist in treatment of NSCLC amongst different hospital types. Patients treated at research/teaching hospitals hospital are more likely to receive surgery as 1st line compared to Community and Comprehensive hospital for stage I to III NSCLC. [Table: see text]
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Siemerink, E., M. Schaapveld, G. A. Hospers, N. H. Mulder, and J. T. Plukker. "Effect of hospitals on survival and postoperative mortality of stomach cancer: A population-based study on type, referral, and volume-effect in the northeast Netherlands." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e15564-e15564. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e15564.
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e15564 Background: To optimize treatment results of patients with stomach cancer some institutions prompt referral to high volume hospitals with experienced surgeon's analogue to esophageal cancer. We analyzed if evidence can be found for superior treatment outcome depending on hospital type, referral pattern or hospital volume. Methods: Data from all patients diagnosed with primary invasive stomach cancer from 1994–2006 were obtained from the nationwide Netherlands Cancer Registry of the north-east part of the Netherlands. This area is served by one university hospital (U), 4 teaching hospitals (T), and 18 non-teaching hospitals (N-T). Results: In the study period, 5243 patients were diagnosed with stomach cancer (65.6% men, 34.4% female), 44.5% underwent surgery. Older age, advanced stage and proximal tumor location resulted in a lower probability of tumor resection. The 5 year relative survival (5yrsurv) was similar in the three hospital types. However, patients with proximal tumors were more often referred for surgery to U (18%), especially by N-T hospitals. In the non-proximal tumors the 5yrsurv was significantly better in U versus T and N-T hospitals, also after multivariate analysis. The significantly better 5yrsurv of low referral centers disappeared after excluding hospital U. No volume effect could be observed. Postoperative mortality registered in the period from 2004–2006 showed no differences between the hospitals. Conclusions: We found highly superior survival for non-proximal tumors but not for proximal cancer in an university hospital. In this study no evidence was found for a referral or volume effect. [Table: see text] No significant financial relationships to disclose.
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Karim, Safiya, Kelly Brennan, Yingwei Peng, William J. Mackillop, and Christopher M. Booth. "Estimating the optimal rate of adjuvant chemotherapy utilization in stage III colon cancer." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 6591. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.6591.
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6591 Background: Identifying optimal chemotherapy utilization rates can drive improvements in quality of care. We report a benchmarking approach to estimate the optimal rate of adjuvant chemotherapy (ACT) for stage III colon cancer. Methods: The Ontario Cancer Registry was linked to electronic chemotherapy records to identify ACT utilization among a random 25% sample of patients with stage III colon cancer diagnosed during 2002-2008 in Ontario, Canada. We explored whether hospital factors (teaching status, regional cancer centre, medical oncologist on-site) were associated with ACT rates. The benchmark population included hospitals with the highest ACT rates that accounted for 10% of the patient population. Hospital ACT rates were adjusted for case mix in a multi-level model accounting for random variation at the hospital level. A Monte Carlo simulation was used to estimate the proportion of observed ACT rate variation that could be due to chance alone. Results: The study population included 2,801patients with stage III colon cancer; ACT was delivered to 66% (1861/2801) of patients. There was no difference in hospital ACT rate by teaching status (64% academic vs 67% non-academic, p = 0.107), comprehensive cancer centre status (65% cancer centre vs 67% non-cancer centre, p = 0.362), or having medical oncology on site (67% on site vs 66% not on site, p = 0.840). After excluding hospitals that had case volumes less than 10 (N = 150), unadjusted ACT rates varied across hospitals (range 44% to 91%, p = 0.017). The unadjusted benchmark ACT rate was 81% (95%CI 76%-86%); utilization rate in non-benchmark hospitals was 65% (95%CI 63%-66%). When using adjusted ACT rates in a multi-level model significant variation remained across hospitals (p < 0.001). The adjusted benchmark ACT rate was 74% (95%CI 63%-83%); non-benchmark hospital ACT rate was 65% (95%CI 53%-75%). The simulation analysis suggested that the non-random component of ACT rate variation across hospitals was 1.5%. Conclusions: There is significant variation in ACT rates across hospitals in routine practice. The estimated benchmark ACT rate is 74%. However, simulation analyses suggest that most of the variation in ACT utilization across hospitals may be due to chance alone.
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Nakayama, Hideki, Yasushi Toh, Manami Fujishita, and Hitoshi Nakagama. "Present status of support for adolescent and young adult cancer patients in member hospitals of Japanese Association of Clinical Cancer Centers." Japanese Journal of Clinical Oncology 50, no. 11 (August 6, 2020): 1282–89. http://dx.doi.org/10.1093/jjco/hyaa141.
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Abstract Background the proportion of adolescent and young adult cancer patients is relatively small, but they require age-specific support. We conducted a survey on the present status of support for adolescent and young adult cancer patients in the Japanese Association of Clinical Cancer Centers. Methods in December 2018, the primary questionnaires were sent to 32 hospitals of Japanese Association of Clinical Cancer Centers regarding support for adolescent and young adult cancer patients. Secondary questionnaires were sent to doctors, nurses and medical social workers in 24 hospitals for the implementation rates of information provision and consultation on 17 unmet needs identified in the study by the Ministry of Health, Labour and Welfare, Japan. Results there were marked differences in support for adolescent and young adult cancer patients among hospitals. Only one hospital facilitated an adolescent and young adult department and ward. Thirteen hospitals cooperated with the paediatric cancer designated hospitals. A learning support for high school-aged patients was provided in 15 hospitals. Adolescent and young adult support teams were active in seven hospitals and staff training sessions were held in eight hospitals. Many hospitals had referrals for fertility preservation. The rates of information provision and consultation for more than 70% of adolescent and young adult patients showed statistically significant differences among the medical professions in most of the 17 items. Conclusions support systems and activities for adolescent and young adult cancer patients vary extremely across hospitals. Information provision and consultation for unmet needs are still insufficient. Therefore, sharing information and experiences is required to enhance the support for adolescent and young adult cancer patients.
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Veenstra, Christine Marie, Andrew J. Epstein, Craig Evan Pollack, and Katrina Armstrong. "Does hospital academic status impact colon cancer care value?" Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 6. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.6.
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6 Background: Given the high cost of cancer care, delivery of high-value care is crucial. The effect of hospital academic status on value of care for patients with stage II and III colon cancer is unknown. Methods: SEER-Medicare cohort study of 20,118 patients age 66+ with stage II or III colon cancer diagnosed 2000-2005 and followed through December 31, 2007. Patients were assigned to a treating hospital based on hospital affiliation of the primary oncologist. We constructed Kaplan-Meier curves to assess unadjusted overall survival. We estimated a Cox proportional hazards model to assess adjusted overall survival. To examine associations between hospital academic status and mean cost of care we estimated a generalized linear model (GLM) with log link and gamma family. We estimated quantile regression models to examine associations between hospital teaching status and cost at various quantiles (25th, 50th, 75th, 90th, 95th, 99th, 99.5th, 99.9th). Standard errors were adjusted to account for clustering of patients within hospitals. Results: 4449/20,118 (22%) patients received care from providers affiliated with academic hospitals. There was no significant difference in unadjusted median survival based on hospital academic status for patients with stage II (academic 6.4 yrs vs. non-academic 6.3 yrs, p=0.711) or stage III disease (academic 4.2 yrs vs. non-academic 4.2 yrs, p=0.81). After adjustment, treatment at academic hospitals was not associated with significantly reduced risk of death from colon cancer (stage II HR 1.05, 95% CI: 0.97 - 1.13; p=0.23; stage III HR 0.99, 95% CI: 0.94-1.07; p=0.98). Excepting stage III patients at the 99.9th percentile of costs, there were no significant differences in adjusted costs between academic and non-academic hospitals. Conclusions: We find no difference in overall survival for patients with stage II or stage III colon cancer based on academic status of the treating hospital. Furthermore, costs of care are similar between academic and non-academic hospitals across virtually the full range of the cost distribution. Most colon cancer patients do not receive cancer care at academic hospitals. Our findings indicate that for patients with stage II or III disease, this inequity does not impact the value of care.
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McDade, Theodore P., Jillian K. Smith, Zeling Chau, Elan R. Witkowski, James K. West, and Jennifer F. Tseng. "Inequal benefits from regionalization of cancer care: The pancreatic cancer surgery paradigm." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 4059. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.4059.
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4059 Background: Regionalization has been proposed for high-level care, including multidisciplinary cancer treatment and complex procedures. Pancreatic resections can serve as a marker for both. Using Massachusetts Division of Health Care Finance and Policy (DHCFP) data, we investigated regionalization of surgery for pancreatic cancer (PCa), its potential effect on perioperative outcomes, and disparities in access to high-volume PCa surgery centers. Methods: Using MA DHCFP Hospital Inpatient Discharge Data, 2005-2009, 10,524 discharges for PCa were identified, of which 746 were associated with pancreatic resection. Discharges with missing or out-of-state residence were excluded (n=704). Using geodetic methods and ZIP codes, center-to-center distances were calculated between patient (pt) and treating hospital. Median ZIP income was estimated from 2009 census data. High volume hospitals (4 of 25 performing pancreatic resections in MA) were defined using Leapfrog Criteria (> 11 per year (87th percentile for MA). Chi-square and logistic regression analyses were performed using SAS software. Results: Median age was 65. Pts were predominantly White (87.2%), with median ZIP income of $54,677. Pts travelled in-state up to 112 miles (median 15.4), with the majority resected at high volume hospitals (76%). Median length of stay (LOS) was 8.0 days, with LOS>1 week associated with low volume hospitals (p=0.0002). Of 14 in-hospital deaths, 7 were at low volume hospitals (4.14% of 169 pts) compared to 7 at high volume hospitals (1.31% of 535 pts) (p=0.0214). Predictors of shorter travel distance were: Black race (OR 4.45 (95% CI 1.66-11.93)), operation at low volume hospital (OR 2.62 (95% CI 1.81-3.77), and increased age (per year) (OR 1.02 (95% CI 1.00-1.03), but not sex or median income. Conclusions: Using MA statewide discharge data, regionalization of pancreatic cancer surgery to high-volume, better-outcome centers is seen to be occurring. However, it is not uniform, and disparities exist between groups of cancer pts that do and do not travel for their care. In the current era of scrutiny on cost, quality, and access to cancer care, further study into predictors of pts receiving optimal care is warranted.
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Richards, Catherine A., Jason Dennis Wright, Alfred I. Neugut, Jeffrey Ascherman, and Dawn L. Hershman. "Influence of hospital characteristics on immediate breast reconstruction following mastectomy." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 6118. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.6118.
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6118 Background: Immediate breast reconstruction (IBR) following mastectomy is underutilized in the U.S. Racial, economic and geographic factors are associated with lower rates of IBR. Prior research has explored the association of individual and surgeon-level factors with the use of IBR, with little attention paid to hospital characteristics. Methods: We analyzed data from the 2008 Nationwide Inpatient Sample (NIS), a 20% random sample of academic, public and private U.S. hospitals. We used ICD-9 codes to identify women diagnosed with invasive breast cancer or DCIS who underwent mastectomy, and IBR (natural or expander/implant). If a hospital performed at least one IBR during 2008, they were classified as performing reconstruction. Relative risk regression was used to assess the hospital factors associated with a hospital performing IBR. Results: Of the 3,518 hospitals that performed mastectomy in 2008 only 50.4% performed at least one IBR. For hospitals that did not perform IBR, the average number of mastectomies was 5, compared to 35 at hospitals that did perform IBR (p<0.01). Among hospitals that did perform IBR, the mean proportion of mastectomy patients that had IBR was 34% (SD=20). In a multivariable adjusted model, urban/teaching (RR=3.47) and urban/non-teaching (RR=2.86) hospitals were significantly more likely to perform IBR compared to rural hospitals. Hospitals with a high proportion of privately insured patients (RR=1.10) were significantly more likely to perform IBR compared to hospitals with a low proportion of privately insured patients. In contrast, hospitals with a high proportion of publically insured patients (RR=0.24) and hospitals with a high proportion of female patients ≥ 70 years old (RR=0.75) were significantly less likely to perform IBR. Hospital region, hospital ownership status and the proportion of nonwhite patients were not significantly associated with IBR. Conclusions: Almost half of all U.S. hospitals where mastectomies are performed do not have any patients who have undergone IBR. The likelihood a hospital will perform IBR varies significantly by hospital characteristics.
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Ellis, Ryan J., Cary Jo R. Schlick, Joe Feinglass, Mary F. Mulcahy, Al B. Benson, Sheetal M. Kircher, Tony D. Yang, David D. Odell, Karl Bilimoria, and Ryan P. Merkow. "Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?" BMJ Quality & Safety 29, no. 2 (July 31, 2019): 103–12. http://dx.doi.org/10.1136/bmjqs-2019-009742.
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BackgroundChemotherapy quality measures consider hospitals compliant when chemotherapy is recommended, even if it is not received. This may mask shortcomings in cancer care delivery. Objectives of this study were to (1) identify patient factors associated with failure to receive recommended chemotherapy without a documented contraindication and (2) assess hospital variation in failure to administer recommended chemotherapy.MethodsPatients from 2005 to 2015 with breast, colon and lung cancers who failed to receive recommended chemotherapy were identified using the National Cancer Database. Hospital-level rates of failure to administer recommended chemotherapy were calculated, and patient and hospital factors associated with failure to receive recommended chemotherapy were identified by multivariable logistic regression.ResultsA total of 183 148 patients at 1281 hospitals were analysed. Overall, 3.5% of patients with breast, 6.6% with colon and 10.7% with lung cancers failed to receive recommended chemotherapy. Patients were less likely to receive recommended chemotherapy in all cancers if uninsured or on Medicaid (p<0.05), as were non-Hispanic black patients with both breast and colon cancer (p<0.001). Significant hospital variation was observed, with hospital-level rates of failure to administer recommended chemotherapy as high as 21.8% in breast, 40.2% in colon and 40.0% in lung cancers.Conclusions and relevanceThough overall rates are low, failure to receive recommended chemotherapy is associated with sociodemographic factors. Hospital variation in failure to administer recommended chemotherapy is masked by current quality measure definitions and may define a significant and unmeasured difference in hospital quality.
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Clarke, Christina A., Steven M. Asch, Laurence Baker, Karl Bilimoria, R. Adams Dudley, Niya Fong, Merry L. Holliday-Hanson, et al. "Public Reporting of Hospital-Level Cancer Surgical Volumes in California: An Opportunity to Inform Decision Making and Improve Quality." Journal of Oncology Practice 12, no. 10 (October 2016): e944-e948. http://dx.doi.org/10.1200/jop.2016.010819.
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Purpose: Most patients, providers, and payers make decisions about cancer hospitals without any objective data regarding quality or outcomes. We developed two online resources allowing users to search and compare timely data regarding hospital cancer surgery volumes. Methods: Hospital cancer surgery volumes for all California hospitals were calculated using ICD-9 coded hospital discharge summary data. Cancer surgeries included (bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach) were selected on the basis of a rigorous literature review to confirm sufficient evidence of a positive association between volume and mortality. The literature could not identify threshold numbers of surgeries associated with better or worse outcomes. A multidisciplinary working group oversaw the project and ensured sound methodology. Results: In California in 2014, about 60% of surgeries were performed at top-quintile–volume hospitals, but the per-hospital median numbers of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries were four or fewer. At least 670 patients received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer type; 72% of those patients lived within 50 miles of a top-quintile–volume hospital. Conclusion: There is clear potential for more readily available information about hospital volumes to help patient, providers, and payers choose cancer surgery hospitals. Our successful public reporting of hospital volumes in California represents an important first step toward making publicly available even more provider-specific data regarding cancer care quality, costs, and outcomes, so those data can inform decision-making and encourage quality improvement.
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Macharia, Lucy Wanjiku, Marianne Wanjiru Mureithi, and Omu Anzala. "Cancer in Kenya: types and infection-attributable. Data from two National referral hospitals." AAS Open Research 1 (March 4, 2019): 25. http://dx.doi.org/10.12688/aasopenres.12910.3.
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Background:Cancer in Africa is an emerging health problem. In Kenya it ranks third as a cause of death after infectious and cardiovascular diseases. Nearly 31% of the total cancer burden in sub-Saharan Africa is attributable to infectious agents. Information on cancer burden is scanty in Kenya and this study aimed to provide comprehensive hospital based data to inform policies.Method:A cross-sectional retrospective survey was conducted at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH) from 2008 to 2012. Data was obtained from the patients files and the study was approved by the KNH/University of Nairobi and MTRH Ethics and Research Committees. Results: In KNH, the top five cancers were: cervical (62, 12.4%), breast (59, 11.8%), colorectal (31, 6.2%), chronic leukemia (27, 5.4%) and stomach cancer 26 (5.2%). Some 154 (30.8%) of these cancers were associated with infectious agents, while an estimated 138 (27.6%) were attributable to infections. Cancers of the cervix (62, 12.4%), stomach (26, 5.2%) and nasopharynx (17, 3.4%) were the commonest infection-associated cancers. In MTRH, the five common types of cancers were Kaposi’s sarcoma (93, 18.6%), breast (77, 15.4%), cervical (41, 8.2%), non-Hodgkin’s lymphoma (37, 7.4%) and colorectal, chronic leukemia and esophageal cancer all with 27 (5.4%). Some 241 (48.2%) of these cancers were associated with infectious agents, while an estimated 222 (44.4%) were attributable to infections. Kaposi’s sarcoma (93, 18.6%), cancer of the cervix (41, 8.2%) and non-Hodgkin’s lymphoma (37, 7.4%) were the commonest infection-associated cancers.Conclusion:Our results suggest that30.8% and 48.2% of the total cancer cases sampled in KNH and MTRH respectively were associated with infectious agents, while 27.6% and 44.4% were attributable to infections in the two hospitals respectively. Reducing the burden of infection-attributable cancers can translate to a reduction of the overall cancer burden.
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Pfaff, Holger, Christoph Kowalski, Lena Ansmann, and Julia Ingendahl. "Hospital characteristics and breast cancer patients’ evaluation of care." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e17550-e17550. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e17550.
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e17550 Background: There is a large body of research on patient evaluations of care and its associations with patient characteristics, such as the sociodemographics or the severity of diseases. A number of studies have recently been published that consider the characteristics of various hospitals in order to explain the differences in patient evaluations between hospitals in non-oncological patient populations. This study investigates the relationship between13 dimensions of satisfaction and breast center hospital characteristics which account for the patient case mix. Methods: The cross-sectional survey data of 3,601 newly-diagnosed breast cancer patients (response rate: 88% of consenting patients) who were treated in 85 out of 91 breast center hospitals in the German state of North Rhine-Westphalia in 2010 were combined with structural data from a key informant survey from the same hospitals. Multilevel linear regression models were calculated in order to investigate patients’ evaluations of the care differences between hospitals and their associations with hospital characteristics (i.e. teaching status, volume, network size, clinical studies, case manager employed) accounting for patient characteristics (self-rated health, mother language, insurance status, age, education, cancer stage, type of surgery). Results: Patients evaluated non-teaching hospitals as being statistically significantly better in 8 out of 13 satisfaction dimensions. None of the other hospital characteristics were significantly associated with any of the satisfaction dimensions. Overall, the differences between hospitals were small to moderate, with null model ICCs ranging from 0.02 to 0.09 for the different dimensions. Conclusions: Teaching breast cancer hospitals face substantial difficulties in achieving patient evaluations that are as good as those from non-teaching hospitals in Germany. The question of extra staffing for the additional teaching tasks needs to be discussed.
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Dottino, Joseph, Weiguo He, Charlotte C. Sun, Hui Zhao, Karen H. Lu, and Larissa Meyer. "National patient experience data and correlation with in-hospital adverse gynecologic cancer surgical outcomes." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 21. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.21.
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21 Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a patient experience and quality of care measure that impacts hospital reimbursement. HCAHPS data is made available to the public through Centers for Medicare and Medicaid. Given the potential implications for healthcare decision-making, this study sought to determine the utility of hospital-level data from the HCAHPS survey as a predictor of in-hospital postoperative outcomes in gynecologic cancer patients by creating a link with the Nationwide Inpatient Sample (NIS) database, an inpatient care database developed for the Healthcare Cost and Utilization Project (HCUP). Methods: 2009-2011 HCAHPS survey data was used to assign hospitals into terciles by scores. The NIS database was used to identify admissions for cancer-specific surgeries for patients with ovarian, uterine, and cervical cancers. Outcomes included complications, mortality, and prolonged length of stay. Mixed effects models compared correlation of outcomes and HCAHPS scores, after adjustment for patient-level and hospital-level variables. Results: 17,509 linked encounters in 651 hospitals across the U.S. were identified, with 51% uterine, 40% ovarian, and 9% cervical cancer surgical admissions. In-hospital mortality was less likely in hospitals in the highest vs. lowest tercile of summary HCAHPS scores (odds ratio (OR) 0.54, 95% CI: 0.31-0.94). While higher scores were not associated with overall postoperative complications, by complication subcategory, admissions in top tercile hospitals were less likely to have surgical complications (OR 0.82, 95% CI 0.69-0.98). No differences were found in risk of medical or nursing-related complications, or prolonged hospitalization (p > 0.05). Conclusions: For patients undergoing gynecologic oncology surgery, assessment of patient experience has limited correlation with in-hospital adverse surgical outcomes. Awareness of the limitations of HCAHPS survey data may better inform patients as consumers and highlights the importance for transparency of relevant quality measures.
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Revels, Sha'Shonda L., Rishinda Reddy, and Sandra L. Wong. "Underuse of cancer-directed care in Medicaid patients with esophageal cancer." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6637. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6637.
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6637 Background: Among esophageal cancer (EC) patients (pts) there are significant disparities in the use of cancer directed-treatments. We examined the extent to which insurance status explains treatment choices and survival differences. Methods: Using the National Cancer Database Participant User File, we identified 94,399 EC pts (36% private insurance [PI], 51% Medicare, 6% Medicaid and 3% uninsured [UI]), treated at 1,586 hospitals, diagnosed 1998-2010. We evaluated variations in the use of chemotherapy, radiation and surgery with logistic regression. Cox proportional hazards regression was used to assess differences in survival. Models were adjusted for pt and tumor characteristics, as well as clustering. Results: Compared to PI pts, Medicaid pts were more likely to live in neighborhoods with low educational attainment (36 vs. 14%, p<0.01), have annual incomes <$30,000 (32 vs. 11% p<0.01) and present with stage III EC (37 vs. 17%, <0.01). Despite adjustment for pt, tumor and hospital characteristics, Medicaid pts with non-metastatic EC were less likely to undergo surgery (OR 0.43, 95% CI 0.37-0.50) and chemotherapy (OR 0.71, 95% CI 0.60-0.84) compared to PI pts. There were no differences in the use of radiation. Hospital resection rates were inversely related to Medicaid/UI case mix. The risk-adjusted resection rate for Medicaid pts at hospitals with relatively few Medicaid/UI pts was 42%, compared to 33% in hospitals with higher case mix (p<0.01). Pts at hospitals with higher Medicaid/UI case mix experienced poorer risk-adjusted survival (HR 1.16, 95% CI 1.11-1.23). Survival differences were attenuated after accounting for receipt of surgery (HR 1.09, 95%CI 1.04-1.15), but not for chemotherapy or radiation. Conclusions: Poorer survival among pts treated at hospitals with high Medicaid/UI case mix is, in part, related to the underuse of surgery. Reducing cancer deaths in disadvantaged populations will require stakeholders to gain an understanding of why these pts are less likely to get to the operating room. In addition, steps must be taken to assure that hospitals with higher Medicaid/UI case mixes are equipped to provide quality cancer care, particularly in light of upcoming Medicaid expansion.
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Spaulding, Aaron, Rachel Paul, and Dorin Colibaseanu. "Comparing the Hospital-Acquired Condition Reduction Program and the Accreditation of Cancer Program: A Cross-sectional Study." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 55 (January 1, 2018): 004695801877029. http://dx.doi.org/10.1177/0046958018770294.
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Under the Hospital-Acquired Condition Reduction Program (HACRP), introduced by the Affordable Care Act, the Centers for Medicare and Medicaid must reduce reimbursement by 1% for hospitals that rank among the lowest performing quartile in regard to hospital-acquired conditions (HACs). This study seeks to determine whether Accredited Cancer Program (ACP) hospitals (as defined by the American College of Surgeons) score differently on the HACRP metrics than nonaccredited cancer program hospitals. This study uses data from the 2014 American Hospital Association Annual Survey database, the 2014 Area Health Resource File, the 2014 Medicare Final Rule Standardizing File, and the FY2017 HACRP database (Medicare Hospital Compare Database). The association between ACPs, HACs, and market characteristics is assessed through multinomial logistic regression analysis. Odds ratios and 95% confidence intervals are reported. Accredited cancer hospitals have a greater risk of scoring in the Worse outcome category of HAC scores, vs Middle or Better outcomes, compared with nonaccredited cancer hospitals. Despite this, they do not have greater odds of incurring a payment reduction under the HACRP measurement system. While ACP hospitals can likely improve scores, questions concerning the consistency of the message between ACP hospital quality and HACRP quality need further evaluation to determine potential gaps or issues in the structure or measurement. ACP hospitals should seek to improve scores on domain 2 measures. Although ACP hospitals do likely see more complex patients, additional efforts to reduce surgical site infections and related HACs should be evaluated and incorporated into required quality improvement efforts. From a policy perspective, policy makers should carefully evaluate the measures utilized in the HACPR.
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Wong, S. L., H. Ji, and J. D. Birkmeyer. "Extent of lymphadenectomy and survival in stomach cancer." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 17008. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.17008.
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17008 Background: Based on population-based studies, some investigators have posited that patients undergoing more extensive lymphadenectomy as part of their resection for stomach cancer had improved late survival rates. Such findings have prompted calls for the use of total lymph node counts as a quality indicator for hospitals. However, apparent relationships between number of lymph nodes resected and survival may be confounded by patient selection bias and provider factors. It is not clear that hospitals with higher lymph node counts have better outcomes than other hospitals. The purpose of this study is to examine relationships between total lymph node counts and survival for stomach cancer. Methods: Using the national Surveillance Epidemiology and End Results (SEER)-Medicare linked database (1992–2002), we first identified all patients undergoing major resections for gastric cancer (n=3,049). Hospitals at which the procedures were performed were categorized into 3 groups (terciles) according to the median number of nodes examined. We then assessed 5-year survival rates for each hospital group, adjusting for potentially confounding patient and hospital characteristics. Results: Hospitals with the highest median lymph node counts had slightly higher 5-year survival rates than those with the lowest node counts (31% vs. 28%; unadjusted HR for mortality 0.90, 95% CI 0.81–1.00). Hospitals with higher lymph node counts tended to treat lower risk patients and had lower procedure volumes. Adjusting for these confounding patient and provider characteristics further weakened the apparent relationship between survival and lymph node counts by hospital (adjusted HR, high vs. low hospital tercile, 0.96; 95% CI 0.85–1.09). Conclusions: Apparent relationships between total lymph node counts by hospital and 5-year survival rates after resection for stomach cancer are relatively weak and explained in large part by confounding patient and provider factors. Stronger evidence should be required before moving forward with this metric as a hospital quality indicator. No significant financial relationships to disclose.
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Frosch, Zachary AK, Nicholas Illenberger, Nandita Mitra, Daniel J. Boffa, Matthew A. Facktor, Heidi Nelson, Justin E. Bekelman, Lawrence N. Shulman, and Samuel U. Takvorian. "Association of hospital type and patient volume growth with timely cancer treatment." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 2022. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.2022.
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2022 Background: Studies have suggested superior outcomes for patients with cancer treated at National Cancer Institute (NCI) and academic hospitals, leading some to advocate for complex cancer care to be delivered at regional referral centers. However, growing demand at such centers may exceed their capacity to provide timely treatment, which could be detrimental to patient outcomes. We evaluated the relationship between hospital type, the average annual growth rate in patient volume (PV), and time to treatment initiation (TTI) trends. Methods: We used the National Cancer Database to identify patients undergoing initial treatment for a new diagnosis of cancer (breast, lung, prostate, colorectal, melanoma, bladder, non-Hodgkin lymphoma, renal, uterine or pancreatic) in 2007-2016. The exposure was hospital type (NCI, academic, community or integrated network). The primary outcome was TTI over time. We estimated both the average annual growth rate for PV and adjusted TTI trends by hospital type using linear mixed effects models, including a hospital type-by-time interaction and, when modeling TTI, a patient volume-by-time interaction. Results: We identified 4,218,577 patients treated at 1351 hospitals (49% at 897 community, 23% at 177 academic, 14% at 50 NCI and 14% at 227 integrated network hospitals). Over the study period, PV grew by 40% at NCI and 25% at academic hospitals, compared to 8% at community hospitals (p-value for trend both < 0.001). Meanwhile, mean TTI increased by 3.2 days at community, remained stable at academic (+0.3 days) and decreased by 4.3 days at NCI hospitals (p-value for trend both < 0.001 vs community). A higher annual PV growth rate was associated with a statistically but not clinically significant TTI increase (0.05 days for each 100 patient/year increase in the growth rate, p = 0.001). Conclusions: Patients with newly diagnosed cancer are increasingly receiving treatment at NCI and academic hospitals. While TTI at NCI and academic hospitals is longer than in the community, PV growth has been possible without delaying cancer treatment. Further study is needed to determine whether continued growth at this rate is sustainable. [Table: see text]
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Stewart, A. K., E. G. Gay, L. Patel-Parekh, D. P. Winchester, S. B. Edge, and C. Y. Ko. "Provider feedback improves reporting on quality measures: National profile reports for adjuvant chemotherapy for stage III colon cancer." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 6572. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.6572.
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6572 Background: The National Quality Forum recently announced accountability measures including use of chemotherapy (ACT) with Stage III colon cancer. This study examines the impact of performance reporting using cancer registry data to assess the quality of care for Stage III colon cancer patients using the Commission on Cancer's (CoC) Cancer Program Practice Profile Reports. Cancer registries are the primary source for measurement but adjuvant treatment may be incomplete. Methods: In January 2005 the CoC provided reports to 1,337 hospitals using registry data on over 80,000 Stage III colon cancer patients diagnosed from 1998–2003. Each hospital received a weighted performance rate (PR) and comparison to hospitals of similar types, nationally and regionally. Hospitals could review and correct missing or inaccurate data to provide an updated profile. Results: The initial overall hospital-level PR was 66.2%, hospitals in the top quartile had PRs =80.1%. After 24 months 603 hospitals had corrected data. The mean PR was 74.9%, an increase of 8.7%. The top quartile PR was =89.7%. The PRs for hospitals in the top quartile increased on average by 4.3%, and for hospitals outside this group by 22.7%. The proportion of hospitals with PRs =90% increased from 7.9% to 23.9%. Conclusions: With over two-fifths of hospitals correcting data, the concordance rate with ACT in Stage III colon cancer has significantly increased compared to initial registry data. Reporting quality data and allowing auditing and correction on key quality indicators corrects the data gap in cancer registry out-patient treatment data. Exposure to profile reports can spur local providers to promote better communication with centralized data repositories, significantly contributing to the assessment of care provided to cancer patients. No significant financial relationships to disclose.
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Bhoo-Pathy, Nirmala, Chiu-Wan Ng, Gerard Chin-Chye Lim, Nor Saleha Ibrahim Tamin, Richard Sullivan, Nanthini Thevi Bhoo-Pathy, Matin Mellor Abdullah, et al. "Financial Toxicity After Cancer in a Setting With Universal Health Coverage: A Call for Urgent Action." Journal of Oncology Practice 15, no. 6 (June 2019): e537-e546. http://dx.doi.org/10.1200/jop.18.00619.
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BACKGROUND: Financial toxicity negatively affects the well-being of cancer survivors. We examined the incidence, cost drivers, and factors associated with financial toxicity after cancer in an upper-middle-income country with universal health coverage. METHODS: Through the Association of Southeast Asian Nations Costs in Oncology study, 1,294 newly diagnosed patients with cancer (Ministry of Health [MOH] hospitals [n = 577], a public university hospital [n = 642], private hospitals [n = 75]) were observed in Malaysia. Cost diaries and questionnaires were used to measure incidence of financial toxicity, encompassing financial catastrophe (FC; out-of-pocket costs ≥ 30% of annual household income), medical impoverishment (decrease in household income from above the national poverty line to below that line after subtraction of cancer-related costs), and economic hardship (inability to make necessary household payments). Predictors of financial toxicity were determined using multivariable analyses. RESULTS: One fifth of patients had private health insurance. Incidence of FC at 1 year was 51% (MOH hospitals, 33%; public university hospital, 65%; private hospitals, 72%). Thirty-three percent of households were impoverished at 1 year. Economic hardship was reported by 47% of families. Risk of FC attributed to conventional medical care alone was 18% (MOH hospitals, 5%; public university hospital, 24%; private hospitals, 67%). Inclusion of expenditures on nonmedical goods and services inflated the risk of financial toxicity in public hospitals. Low-income status, type of hospital, and lack of health insurance were strong predictors of FC. CONCLUSION: Patients with cancer may not be fully protected against financial hardships, even in settings with universal health coverage. Nonmedical costs also contribute as important drivers of financial toxicity in these settings.
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Chiu, Connie G., Danielle M. Hari, Anna M. Leung, Jeong-Lim Yoon, Myung-Shin Sim, and Anton J. Bilchik. "Are Community Hospitals Meeting the Same Standards as Academic Hospitals for the Multimodal Management of Rectal Cancer?" American Surgeon 78, no. 10 (October 2012): 1172–77. http://dx.doi.org/10.1177/000313481207801035.
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Although multimodal treatment (surgery, chemotherapy ± radiation) has improved survival in patients with rectal cancer, there are inconsistent treatment patterns in hospitals in the United States. The objective of the study was to evaluate whether treatment paradigms have changed for patients with Stage II and III rectal cancer in community hospitals compared with academic research hospitals, i.e., teaching or comprehensive hospitals engaged in research. The National Cancer Database was queried to identify all patients diagnosed with Stage II or III rectal adenocarcinoma between 2000 and 2008. The first course of treatment and patient clinicodemographic factors were evaluated. Of 70,409 patients in the study cohort, 7,235 (62.9%) at community hospitals, 24,465 (66.9%) at comprehensive hospitals, and 14,868 (66.6%) at teaching hospitals received multimodal therapy. Community hospitals were more likely to treat individuals who were older, white, and with lower income compared with the other facility types. Teaching hospitals treated a higher proportion of uninsured patients. Despite differences in patient demographics, community hospitals have increased the use of multimodal treatment for rectal cancer but continue to remain below academic research hospital standards.
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Fletcher, Sean A., Philipp Gild, Alexander P. Cole, Malte Vetterlein, Adam S. Kibel, Toni K. Choueiri, Guru Sonpavde, et al. "The impact of treatment at minority-serving hospitals on outcomes for bladder cancer." Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 492. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.492.
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492 Background: Healthcare for racial minorities is densely concentrated at a small subset of hospitals in the United States. Understanding long-term outcomes at these minority-serving hospitals is highly relevant to elucidating the sources of racial disparities in cancer care. We investigated the impact of treatment at a minority-serving hospital on overall survival and receipt of definitive treatment for bladder cancer. Methods: Using the National Cancer Database, we identified all patients diagnosed with clinically localized, muscle-invasive bladder cancer between 2004 and 2012. Univariate and multivariable analyses were performed to assess the sociodemographic, clinical, and hospital-level factors influencing overall survival and receipt of definitive treatment (radical cystectomy with or without chemotherapy; trimodal therapy) for bladder cancer. Results: In adjusted analyses, there was no significant difference in overall survival between patients treated at minority-serving hospitals versus those treated at non-minority-serving hospitals (HR: 0.95; 95% CI: 0.90-1.01). There was also no significance in receipt of definitive treatment between the two hospital types (OR: 0.85; 95% CI: 0.68-1.06). Black race was independently associated with increased likelihood of mortality (HR: 1.08; 95% CI: 1.03-1.14) and decreased odds of receiving appropriate definitive treatment (OR: 0.73; 95% CI: 0.66-0.82). Conclusions: There was no difference between minority-serving and non-minority-serving hospitals in overall survival or receipt of definitive treatment. Black patients suffered worse survival and were less likely to receive definitive treatment for bladder cancer regardless of the type of hospital in which they were treated.
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Cone, Eugene Blanchard, Ye Wang, Stephen Reese, and Steven Lee Chang. "Impact of facility volume on complications from immunotherapy for renal cell carcinoma." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 672. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.672.
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672 Background: Better outcomes have been generally associated with higher volume providers/hospitals. Recent work found an association between higher volume facilities and survival for advanced cancer patients. Volume and treatment complications for medical cancer therapy is unexplored. We studied a retrospective cohort of patients with metastatic renal cell carcinoma receiving immunotherapy at high and low volume hospitals. Methods: We used Premier Healthcare Data, which includes administrative data from all payors at over 700 community and academic hospitals, and captures 20% of all hospital discharges in the US, including infusions performed in hospital clinics. Using ICD9 codes we identified patients with metastatic renal cell carcinoma treated with nivolumab from 2015-17. Clinicodemographic data were obtained for patients and hospitals. The primary exposure was dichotomized hospital treatment volume (top quartile = high volume). Outcomes were immunotherapy-related complications for which the patient re-presented to the Emergency Department or was readmitted, and readmission for other cause. We performed mixed effects logistic regression adjusting for complex survey design to achieve national representation. Results: We included 15,724 weighted hospital encounters (5,835 at low-volume hospitals and 9,889 at high-volume hospitals). Urban, teaching hospitals were more likely to be high volume, but all patient factors were balanced. We observed 1,457 complications at high volume hospitals and 1,734 at low volume hospitals. There were no significant differences by volume of hospital in overall rates of complications (OR 0.92, 95% CI 0.82-1.09) or in rates of individual complications, with the exception of ocular complications (n=11, all low volume hospitals). We observed that high volume hospitals significantly reduced odds for readmission (OR 0.09, 0.03-0.24) unrelated to immunotherapy complications. Conclusions: We found no difference in immunotherapy-related complication rates by facility volume. This is reassuring for community administration of immunotherapy. Further study is needed to elucidate why we saw significantly more therapy-unrelated readmissions at lower volume hospitals.
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Boffa, Daniel J., Katherine Mallin, Jeph Herrin, Benjamin Resio, Michelle C. Salazar, Bryan Palis, Matthew Facktor, Ryan McCabe, Heidi Nelson, and Lawrence N. Shulman. "Survival After Cancer Treatment at Top-Ranked US Cancer Hospitals vs Affiliates of Top-Ranked Cancer Hospitals." JAMA Network Open 3, no. 5 (May 26, 2020): e203942. http://dx.doi.org/10.1001/jamanetworkopen.2020.3942.
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Blom, T. R., R. A. Somer, W. Shih, M. Sarno, D. McNally, M. Todd, S. Yao, G. Lu-Yao, R. Dipaola, and M. N. Stein. "Variation in local treatment of prostate cancer by hospital within New Jersey." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 14551. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.14551.
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14551 Background: Although prostate cancer diagnosis and treatment vary through the US, few studies have assessed variations in local therapy between multiple hospitals located within a very narrow geographic region. Methods: To determine the variation of diagnosis and treatment of prostate cancer between hospitals in a local region, data was derived and analyzed from 1,301 patients from fifteen Cancer Institute of New Jersey Oncology Group network hospitals. Tumor registry data from patients with a histological confirmed diagnosis of prostate cancer accessioned over a one-year period between January 1, 2003 and December 31, 2003 was analyzed by a multivariate logistic regression model. Results: Median age of the cohort was 66 and mean number of cases diagnosed at these hospitals for this period was 87 (26–161). When the cohort was assessed overall, 192 cases assessed were African American, 1049 Caucasian, 51 Hispanic, and 32 Asian. Median Gleason score was 6. A total of 463 patients underwent Prostatectomy, and 538 had radiation therapy. Multivariate analysis demonstrated that age and hospital were associated with use of surgery versus no surgery. Race and Gleason score were not associated with use of surgery in this group of hospitals. Multivariate analysis also demonstrated that age and hospital were associated with utilizing radiation therapy versus not utilizing radiation therapy. Again, race and Gleason score were not associated with utilization of radiation therapy in these NJ hospitals. Conclusions: Overall, the most important factors predicting for surgery, and radiation therapy, were age and hospital, which were independent of race and Gleason score. These data support our ongoing assessment of hospital and geographic characteristics that may be responsible for these associations. No significant financial relationships to disclose.
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Halpern, Michael T., Pamela Spain, Debra J. Holden, Andrew Stewart, Erica J. McNamara, E. Greer Gay, Steven B. Clauser, and Irene Prabhu Das. "Association of increases in quality of care with the NCI Community Cancer Center Program (NCCCP) pilot." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 6046. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.6046.
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6046 Background: The NCCCP pilot is an initiative designed to enhance research and improve cancer care at community hospitals. As part of a multi-method evaluation of this pilot, we assessed changes in quality of care among the 16 pilot NCCCP hospitals over time (before vs. after program initiation) and in comparison to a group of 25 similar hospitals that did not participate in the NCCCP. Methods: We compared changes in 5 NQF-approved quality of care measures (3 for breast cancer, 2 for colon cancer) from 2006/07 (before NCCCP initiation) vs. 2008/09/10 (post-initiation) for NCCCP and comparison group hospitals. Data were collected from all study hospitals using the Commission on Cancer’s Rapid Quality Reporting System, which allowed near real-time tracking of quality of care process measures. Results: Analyses included 18,608 breast cancer and 7,031 colon cancer patients. Patient-level concordance rates for all 5 quality of care measures increased significantly among both NCCCP and comparison group hospitals. The change (from baseline to post-NCCCP) in quality of care among NCCCP hospitals was significantly greater than the change among comparison group hospitals for two measures: radiation therapy following breast conserving surgery (RT-BCS) and hormonal therapy for women with hormone receptor positive breast cancer (HT). For the RT-BCS measure, NCCCP patients from underserved populations also experienced significantly greater changes in concordance than did corresponding populations from comparison group hospitals. In multivariate regression analyses controlling for patient characteristics, the change for the HT measure among NCCCP hospitals was significantly greater than that among comparison group hospitals. Conclusions: While both NCCCP and comparison group hospitals showed improved quality of care, participation in the NCCCP was associated with significantly greater improvements for a subset of measures. Including a separate comparison hospital group was critical for assessing changes associated with NCCCP participation while controlling for broader U.S. trends in improved quality of care. Future work will examine how hospital networks may have facilitated improvements in quality of care.
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Wasif, Nabil, Yu-Hui Chang, Amit Mathur, Barbara A. Pockaj, Richard J. Gray, and David Etzioni. "Attenuation of the volume-outcome relationship for gastrointestinal cancer surgery over time: Is a push towards continued regionalization justified?" Journal of Clinical Oncology 35, no. 4_suppl (February 1, 2017): 131. http://dx.doi.org/10.1200/jco.2017.35.4_suppl.131.
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131 Background: Research demonstrating a volume-outcome relationship has resulted in regionalization of complex cancer surgery to high volume hospitals. A simultaneous national trend towards improved surgical outcomes brings into question whether the potential benefits of regionalization are still relevant. We hypothesize that the difference in adjusted post-operative mortality between low and high volume hospitals has decreased over time. Methods: The National Cancer Database (NCDB) was used to identify patients with colon, esophageal, and pancreatic cancer undergoing curative intent surgery from 2003-2011. Hospitals were divided into low ( < 25th percentile), medium (25th-75th) and high ( > 75thpercentile) volume groups depending on annual volume of cancer-specific surgery. Year-specific hospital averaged observed/expected (O/E) ratios were calculated for 90-day mortality. Poisson regression was used to model hospital averaged O/E ratios over time. Results: Our study population included 343,929 patients with colon (88%), esophageal (5%) and pancreatic (7%) cancer. There were significant (p < 0.05) improvements in adjusted 90-day mortality from 2003 and 2011 for all volume categories and cancer types, except in high volume hospitals for esophageal cancer. In 2003, high volume hospitals had significantly better outcomes compared to low volume hospitals for all cancer types, as suggested by lower O/E ratios for 90 day mortality (p < 0.05). However, by 2011 the difference in O/E ratios for 90 day mortality was no longer significantly lower for high compared to low volume hospitals (p > 0.05); this was true for all three cancer types (Figure1). Conclusions: During the period of our study, 90-day mortality following gastrointestinal cancer surgery improved in low, medium and high volume hospitals. However, by 2011 the difference in adjusted post-operative mortality between low and high volume hospitals was not significantly different, likely due to global improvements in operative and peri-operative care. This attenuation of the volume-outcome curve has important implications for policy pertaining to regionalization of cancer care in the US.
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Friese, C. R., and L. H. Aiken. "Surgical oncology outcomes: The role of nurse practice environments." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 6105. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.6105.
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6105 Background: Increased attention has focused on the role of hospital characteristics on cancer patient outcomes. We examined two cancer-specific credentials, as well registered nurse practice environments, on outcomes of care. Methods: Through secondary analysis of existing data from hospital claims, the tumor registry, and a statewide of survey of nurses (RNs), we studied 30-day mortality (D) and failure to rescue (death given a complication) (FTR) for surgical oncology patients treated in 164 Pennsylvania hospitals from 1998–1999 (N=24,618). We compared D and FTR rates by a hospital’s NCI cancer center designation, American College of Surgeon’s (ACoS) cancer program approval and categorized scores on the Practice Environment Scale of the Nursing Work Index (PES-NWI). The PES-NWI scales measure RN participation in hospital affairs, RN foundations for quality of care, nurse manager leadership/support, staffing/resource adequacy, and RN-physician relations. Multivariate logistic regression models examined predictors of D and FTR, controlling for 25 patient variables. Standard errors were corrected for patient clustering in hospitals. Results: NCI centers had lower D and FTR rates (p < .01). ACoS hospitals had lower D and FTR rates (ns). Hospitals with low scores on PES-NWI scales had the poorest outcomes (p < .01). In logistic regression models, significant predictors included unfavorable PES-NWI Scores for D (OR=1.32, 95% CI: 1.06–1.65) and FTR (OR=1.39, 95% CI:1.03–1.88), and NCI centers for D (OR=0.64, 95% CI: 0.50–0.83) and FTR (OR=0.67, 95% CI: 0.47–0.96). The NCI effect lost significance when environment was included. ACoS program effects were small (OR= 0.99, p = .90) for both outcomes. Conclusions: Favorable outcomes in NCI centers may be partly explained by practice environments. The practice environment of RNs significantly predicts surgical oncology patient outcomes, and should be a focus of quality improvement activities. No significant financial relationships to disclose.
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Ho, Gwendolyn, Ann Brunson, Richard H. White, and Ted Wun. "Predictors Of Vena Cava Filter Use For Venous Thromboembolism In Cancer Patients." Blood 122, no. 21 (November 15, 2013): 935. http://dx.doi.org/10.1182/blood.v122.21.935.935.
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Abstract Background The use of vena cava filters (VCF) in the treatment of venous thromboembolism (VTE) is controversial. Few studies have evaluated the use of VCFs in cancer patients with acute thrombosis. Aims To determine frequency of VCF placement and factors associated with VCF use in patients with cancer hospitalized for acute VTE, and to compare these findings to patients without cancer hospitalized for acute VTE. Methods Using a retrospective observational study design, we analyzed hospital discharge records in California from 2005-2009 of cases presenting with acute VTE. Patients with cancer were identified by specific ICD-9-CM codes for the index VTE admission or a cancer diagnosis within 6 months prior to the index VTE. Bivariate and multivariable logistic regression analyses were used to determine predictive factors for placement of a VCF in cancer patients. Candidate risk factors included basic demographic parameters, cancer type, severity-of-illness (SOI) on admission, undergoing surgery, bleeding, and hospital characteristics. Results A VCF was placed in 19.6% of 14,000 cancer cases admitted with a principal diagnosis of acute VTE, versus 10.8% of 70,472 non-cancer cases admitted during the same time period. Among cancer cases, there was little variation in percentage that received a VCF based on age, and no significant variation across race or insurance type, except that self pay cancer patients had a lower rate of VCF placement. Variation across hospitals in the percentage of cancer cases that received a VCF was striking, ranging from 0% to 52% among hospitals that admitted a minimum of 15 acute VTE cases. There was a strong correlation (r=0.72, R2=0.52) in the frequency of VCF placement in cancer and non-cancer cases within individual hospitals. Among cancer types, the frequency of VCF placement was highest in cases with brain cancer (43%), with the observed frequency of VCF use among other cancer types ranging from 8%-23%. Patients with brain cancers, which has a high perceived bleeding risk were over 4 fold more likely to have a VCF placed compared to those cancers with low bleeding risk. Having acute leukemia did not predict for VCF placement. Only 8.2% of cancer patients had a strict contraindication to anticoagulation (acute bleeding or recent/imminent surgery), which are the only guideline-based indications for VCF placement. Active bleeding and undergoing surgery were each strongly associated with VCF use: 47% of cases that bled and 58% of cases who underwent surgery had a VCF placed. Results of the multivariable logistic model are shown in the table. In addition to bleeding and undergoing surgery, factors associated with VCF insertion included: larger hospital, urban location, private hospital and greater SOI at the time of admission. Conclusions The frequency of VCF use in cancer patients admitted for acute VTE is much higher than in non-cancer patients. Major risk factors for VCF use include bleeding, undergoing recent surgery, having brain cancer, urban location, and greater severity of illness. The frequency of VCF placement among cancer patients varied widely across hospitals. Given the extraordinary variation in the frequency of use of VCFs between hospitals, more research is needed to better define outcomes of VCF placement in cancer patients. Disclosures: Ho: American Society of Hematology: ASH HONORS trainee research award Other.
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Gallaway, Michael Shayne, Eric Tai, and Elizabeth A. Rohan. "Smoking Cessation Treatment Programs Offered at Hospitals Providing Oncology Services." Journal of Smoking Cessation 14, no. 1 (April 30, 2018): 65–71. http://dx.doi.org/10.1017/jsc.2018.15.
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Background: Many people with cancer continue smoking despite evidence that it negatively effects cancer treatment, worsens chemotherapy toxicity, and increases risk for a second cancer.Aims: We examined tobacco treatment services offered to cancer patients at hospitals providing oncology services, including National Cancer Institute (NCI)-Designated Cancer Centers (NDCCs).Methods: We examined survey data of 6,400 U.S. hospitals from 2008 to 2015 to determine the manner in which tobacco treatment/cessation program services were provided among NDCCs and non-NDCC hospitals providing oncology services (HPOs).Results: From 2008 to 2015, 784 responses from NDCCs and 18,281 responses from HPOs were received. NDCCs (86%) reported significantly higher tobacco treatment/cessation programs owned by the hospital compared to HPOs (68%) (p < 0.001). Among NDCCs, there was a significant increasing trend of tobacco treatment/cessation programs reported owned by the hospital, the health system, or other contractual mechanism from 2008 to 2015 (p = 0.03).Conclusions: More than 80% of oncology providing hospitals report providing tobacco cessation programs, with higher percentages reported in NDCCs. As hospitals implement smoking cessation programs, partnerships between hospitals and cancer coalitions could help bring tobacco cessation activities to communities they both serve, and link discharged patients to these cessation resources so they can continue quit attempts that they initialised while hospitalised.