With Ovarian Cancer, Better Outcome Tied to Guideline Adherence
(HealthDay News) – High-volume providers are significantly more likely to provide National Comprehensive Cancer Network (NCCN) guideline-adherent care and are associated with improved survival outcomes, according to a study presented at the Society of Gynecologic Oncology's Annual Meeting on Women's Cancer, held from March 9–12 in Los Angeles.
Robert E. Bristow, MD, from University of California Irvine Medical Center, and colleagues identified 13,321 consecutive patients from the California Cancer Registry diagnosed with epithelial ovarian cancer (Jan. 1, 1999–Dec. 31, 2006) undergoing a minimum surgical procedure of oophorectomy. Stage-appropriate surgical procedures and recommended chemotherapy was the definition of adherence to NCCN guideline care.
The researchers found that, overall, 37.2% of patients received NCCN guideline-adherent care. Nearly 19% of cases were seen at high-volume hospitals (≥20 cases/year) and 16.4% of surgeries were performed by high-volume surgeons (≥10 cases/year). Guideline-adherent care was significantly more likely at high-volume hospitals (50.8%) compared to low-volume hospitals (34.1%). Guideline-adherent care was also significantly more likely among high-volume surgeons (47.6%) compared to low-volume surgeons (34.5%). On multivariate survival analysis, controlling for patient, disease-related, and health care system factors, nonadherence to NCCN guideline care was independently associated with inferior overall survival (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.26–1.42). Both low-volume hospitals (HR, 1.08; 95% CI, 1.01–1.16) and low-volume surgeons (HR, 1.18; 95% CI, 1.09–1.28) were independently associated with worse overall survival after adjusting for NCCN guideline adherence.
"Adherence to NCCN guidelines for treatment of ovarian cancer is correlated with overall survival and may be a useful process measure of quality cancer care," the authors write.