Abstract
ObjectiveTo characterize the impact of hospital and physician ovarian cancer case volume on survival for advanced-stage disease and investigate socio-demographic variables associated with access to high-volume providers. MethodsConsecutive patients with stage IIIC/IV epithelial ovarian cancer (1/1/96–12/31/06) were identified from the California Cancer Registry. Disease-specific survival analysis was performed using Cox-proportional hazards model. Multivariate logistic regression analyses were used to evaluate for differences in access to high-volume hospitals (HVH) (≥20cases/year), high-volume physicians (HVP) (≥10cases/year), and cross-tabulations of high- or low-volume hospital (LVH) and physician (LVP) according to socio-demographic variables. ResultsA total of 11,865 patients were identified. The median ovarian cancer-specific survival for all patients was 28.2months, and on multivariate analysis the HVH/HVP provider combination (HR=1.00) was associated with superior ovarian cancer-specific survival compared to LVH/LVP (HR=1.31, 95%CI=1.16–1.49). Overall, 2119 patients (17.9%) were cared for at HVHs, and 1791 patients (15.1%) were treated by HVPs. Only 4.3% of patients received care from HVH/HVP, while 53.1% of patients were treated by LVH/LVP. Both race and socio-demographic characteristics were independently associated with an increased likelihood of being cared for by the LVH/LVP combination and included: Hispanic race (OR=1.72, 95%CI=1.22–2.42), Asian/Pacific Islander race (OR=1.57, 95%CI=1.07–2.32), Medicaid insurance (OR=2.51, 95%CI=1.46–4.30), and low socioeconomic status (OR=2.84, 95%CI=1.90–4.23). ConclusionsAmong patients with advanced-stage ovarian cancer, the provider combination of HVH/HVP is an independent predictor of improved disease-specific survival. Access to high-volume ovarian cancer providers is limited, and barriers are more pronounced for patients with low socioeconomic status, Medicaid insurance, and racial minorities.
Highlights
The United States accounts for approximately 10% of the world ovarian cancer burden, with an estimated 22,240 new cases being diagnosed in 2013 and 14,030 disease-related deaths [1,2]
Among patients with advanced-stage ovarian cancer, the provider combination of high-volume hospitals (HVH)/high-volume physicians (HVP) is an independent predictor of improved disease-specific survival
The median ovarian cancer-specific survival for all patients was 28.2 months, and on multivariate analysis the HVH/HVP provider combination (HR = 1.00) was associated with superior ovarian cancer-specific survival compared to low-volume hospital (LVH)/LVP (HR = 1.31, 95% confidence intervals (95%CI) = 1.16–1.49)
Summary
The United States accounts for approximately 10% of the world ovarian cancer burden, with an estimated 22,240 new cases being diagnosed in 2013 and 14,030 disease-related deaths [1,2]. Inadequate access to high-volume providers for disease processes with a demonstrated positive volume–outcome relationship has contributed to widespread racial disparities in cancer care in the United States [7]. The extent to which racial and socioeconomically based differences in access to high-volume providers contribute to disparities in treatment and survival has not been well characterized [8]. The primary objective of the current study was, to investigate the impact of socio-demographic variables, including race, payer status, and socioeconomic status (SES), on access to highvolume ovarian cancer hospitals and physicians in the most clinically challenging patient population —those with stage IIIC/IV disease. We aimed to characterize the combined impact of both hospital and physician case volume on ovarian cancer-specific survival
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