Are many community hospitals undertreating breast cancer? Lessons from 24,834 patients

Juan C. Gutierrez, Judith D. Hurley, Nadine Housri, Eduardo A. Perez, Margaret M. Byrne, Leonidas G. Koniaris

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28 Scopus citations

Abstract

To compare treatment patterns and long-term outcomes between teaching and community hospitals treating patients with infiltrating ductal carcinoma (IDC). METHODS:: All IDCs from the Florida Cancer Data System from 1994 to 2000 were examined. RESULTS:: Overall, 24,834 operative cases of IDC were identified. Teaching hospitals treated 11.3% of patients with a larger proportion of stage III and IV disease (39.8% vs. 33.0%). Five- and 10-year overall survival rates at teaching hospitals were 84% and 72%, compared with 81% and 69% at high-volume community hospitals and 77% and 63% at low-volume hospitals (P < 0.001). The greatest differences on survival were observed in patients with advanced IDC. Examination of practice patterns demonstrated that multimodality therapy was most frequently administered in teaching hospitals. Breast-conserving surgery was more frequently performed at teaching hospitals (41.5% vs. 38.9% P = 0.008). On multivariate analysis, it was found that treatment at a teaching hospital was a significant independent predictor of improved survival (hazard ratio = 0.763, P < 0.001). This survival benefit was greater and independent of high-volume center status (hazard ratio = 0.903, P < 0.02). CONCLUSIONS:: Patients with IDC treated at teaching hospitals have significantly better survival than those treated at high-volume centers or community hospitals, particularly in the setting of advanced disease. Poorer long-term outcomes for IDC at community hospitals seem to be, at least in part, because of decreased use of proven life-extending adjuvant therapies. These results should encourage community hospitals to institute changes in treatment approaches to invasive breast cancer to optimize patient outcomes.

Original languageEnglish (US)
Pages (from-to)154-162
Number of pages9
JournalAnnals of surgery
Volume248
Issue number2
DOIs
StatePublished - Aug 1 2008

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ASJC Scopus subject areas

  • Surgery

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