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 Koniaris

Research output: Contribution to journalArticle

26 Citations (Scopus)

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 2008
Externally publishedYes

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Community Hospital
Teaching Hospitals
Ductal Carcinoma
Breast Neoplasms
High-Volume Hospitals
Survival
Low-Volume Hospitals
Therapeutics
Segmental Mastectomy
Information Systems
Multivariate Analysis
Survival Rate
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Are many community hospitals undertreating breast cancer? Lessons from 24,834 patients. / Gutierrez, Juan C.; Hurley, Judith D.; Housri, Nadine; Perez, Eduardo A.; Byrne, Margaret M.; Koniaris, Leonidas.

In: Annals of Surgery, Vol. 248, No. 2, 08.2008, p. 154-162.

Research output: Contribution to journalArticle

Gutierrez, Juan C. ; Hurley, Judith D. ; Housri, Nadine ; Perez, Eduardo A. ; Byrne, Margaret M. ; Koniaris, Leonidas. / Are many community hospitals undertreating breast cancer? Lessons from 24,834 patients. In: Annals of Surgery. 2008 ; Vol. 248, No. 2. pp. 154-162.
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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.",
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