What Impact Does Hospital Volume Have on Ovarian Cancer Survival?
Ovarian cancer is one of the most difficult cancers to treat. Though overall survival is generally over 90% if caught early, only about 15% of ovarian cancers are diagnosed at early stages. This means that many women are diagnosed with ovarian cancer at more advanced stages with high mortality.
With something as deadly as ovarian cancer, any patient and her family want to make sure they are getting the best possible chance at battling the disease.
First, you need to find a doctor that you trust. Secondly, you must be on the lookout for the best possible treatment that you can get.
Deciding where to go for ovarian cancer treatment can be very difficult
So where can you turn? Do you dive into the sea of reviews and advertisements littered throughout the internet to find a private doctor, or do you check yourself into the closest public hospital in your area? Most people have a general mindset in place as to what they think of as "good" quality hospitals, but how accurate is this perception really? Is going to a big-name Harvard-affiliated hospital really going to give you a better chance than the doctor down the street who is well-loved amongst your community? Deciding who to turn to is a difficult decision to make.
Do big-city hospitals have better outcomes for ovarian cancer patients?
For some time, it's been observed that high-volume institutions such as busy, big-city hospitals have much better quality of care for patients diagnosed with ovarian cancers. It makes sense and seems logical enough. Seeing more of the disease means doctors get more practice treating it and experiencing what works best for patients. The more experienced the doctors are with the condition, the more they know about what works for people and what doesn't. On top of that, they are more inclined to stay up to date with the latest research involved with the disease and might know of resources for clinical trials or experimental treatments that might benefit particularly difficult-to-treat cases.
“Practice makes perfect” is the general sentiment of many patients and doctors alike
It has been the traditional sentiment of many doctors and patients alike to believe that when it comes to skill, the more you practice you get, the better you get. This sentiment still holds much weight in the medical field, where it's been long accepted that having more patient cases leads to better quality care and outcomes for those patients. For example, surgeons who perform hundreds more thyroid surgeries than others have lower complication rates. This phenomenon has been widely accepted for some time, and ovarian cancer is no exception.
Some women don't have options to go to a well-known institution to treat their disease
Unfortunately for us, ovarian cancer doesn't discriminate, targeting women living in urban and rural areas alike. In reality, many women who get ovarian cancer will be living in places where they don't have access to a big city hospital with high volume. It seems hardly fair that these women receive sub-optimal care simply because of their residential status.
What kinds of options do these women have?
A study looked at whether high-volume hospitals did better than low-volume hospitals in treating ovarian cancer
Recently, a new study looked at trends in ovarian cancer care and compared them amongst hospitals that varied in patient volume. Dr. Jason Wright is a gynecologic oncologist at Columbia University in New York City. He and his colleagues performed a retrospective study reviewing patient data of women who were diagnosed with ovarian cancer. They identified these women using the National Cancer Database and analyzed over 100 000 women treated in over 1000 hospitals. Dr. Wright and his team looked at not only survival rates of women treated in these hospitals, but also the adherence of the physicians to the standard of care.
How did they perform this study?
To gather their statistics, they first stratified hospitals based on how many patients were seen. They divided up the institutions into low-volume, low intermediate-volume, intermediate-volume, high intermediate-volume, and high-volume centers. They then looked at not only the survival trends of the patients within these groups of hospitals, but also how often the quality of care was achieved. Quality of care included standard procedures that are supported by strong, evidence-based data from research within the field. Examples include the performance of lymph node dissection for early-stage tumors as well as chemotherapy for high-risk, early-stage tumors.
Results confirmed what many believed: high-volume centers are linked to improved survival and quality of care for ovarian cancer patients.
Dr. Wright found that high-volume centers not only boasted better survival rates than low-volume ones, but they more often adhered to the standard of care as determined by evidence-based research. Comparing low-volume with high-volume institutions, survival jumped from 64.4% to 77.4% respectively. The observed increases in survival appear to correlate with the increased adherence to standard care procedures. The team wondered if we could improve survival rates of low-volume centers by improving quality of standard care.
Does improving quality of care in low-volume hospitals improve survival?
To do this, they looked at survival rates at low-volume centers and compared them based on the level of adherence of these institutions. Though there was a clear correlation even in low-volume centers for improved survival with higher levels of adherence, the survival rate was yet still lower than that achieved in high-volume centers.
Based on their results, the study authors concluded that in general, high-volume centers appear to bring the best outcomes for patients with ovarian cancer. Even if low-volume hospitals adhere to stricter policies and improve their quality of care, the success in treating ovarian cancer is still no match for that achieved by high-volume hospitals.
But still, though we know it's probably better to get ovarian cancer treatment at a high-volume, big-city institution, some women simply don't have access to medical care of this setting. What can we do give these women their best chance?
What can we do for women who must go to low-volume hospitals for their care?
In low-volume hospitals, the best thing to do for treating these patients is to improve the quality of care as much as possible. That means sticking to evidence-based guidelines for management and treatment of ovarian cancer and staying up to date with the latest research. This is much more difficult for doctors and nurses that work in a hospital that doesn't see as many cases of ovarian cancer. It's important that they keep up with the best treatments out there in case they have a patient diagnosed with this disease.
Though the survival rate is still lower than in high-volume institutions, improving survival by any amount is still beneficial for patients.
References
https://www.columbiaobgyn.org/profile/jason-d-wright-md
