Article    Correction    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Summary for Patients    Summary for Patients (PDF)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search    Get Permissions  Google Scholar    Search for Related Content  Social Bookmarking

What's this?

PubMed

Articles in PubMed by Author:    Meyerhardt, J. A.    Fuchs, C. S.    Related Articles in PubMed    PubMed Citation    PubMed

ARTICLE

Association of Hospital Procedure Volume and Outcomes in Patients with Colon Cancer at High Risk for Recurrence

Jeffrey A. Meyerhardt, MD; Paul J. Catalano, ScD; Deborah Schrag, MD, MPH; John Z. Ayanian, MD, MPP; Daniel G. Haller, MD; Robert J. Mayer, MD; John S. Macdonald, MD; Al B. Benson, III, MD; and Charles S. Fuchs, MD, MPH

21 October 2003 | Volume 139 Issue 8 | Pages 649-657

Background: Studies that use registry data have demonstrated superior long-term overall survival after curative surgical resection of colon cancer at hospitals where the volume of such surgeries is high. However, because such administrative data lack information on cancer recurrence, the true nature of this relation remains uncertain.

Objective: To determine whether hospital procedure volume predicts long-term outcomes of colon cancer surgery.

Design: Nested cohort study within a randomized clinical trial.

Setting: Intergroup 0089 national adjuvant colon cancer study conducted between 1988 and 1992.

Patients: 3161 patients with high-risk stage II and stage III colon cancer.

Measurements: Overall survival and recurrence-free survival, by hospital procedure volume as defined by Medicare claims data.

Results: With a median follow-up of 9.4 years, 5-year overall survival significantly differed across tertiles of hospital procedure volume (63.8% for patients who had resection at low-volume hospitals compared with 67.3% at high-volume hospitals; P = 0.04). After adjustment for other predictors of colon cancer outcome, the hazard ratio for overall mortality in patients treated at low-volume centers was 1.16 (95% CI, 1.03 to 1.32). However, the risk for cancer recurrence was not associated with hospital procedure volume. Five-year recurrence-free survival was 63.9% for patients who had resection at low-volume hospitals compared with 63.0% at high-volume hospitals (adjusted hazard ratio, 1.03 [CI, 0.89 to 1.18]). These findings did not materially change after stratification by other potential demographic and clinical predictors of outcome.

Conclusions: According to prospectively recorded data from a large clinical trial, patients whose colon cancer was resected at low-volume hospitals experienced a higher risk for long-term mortality; however, this increased mortality was not attributable to differences in colon cancer recurrences.

Editors' Notes Context Evidence suggests that long-term survival is worst when patients have colorectal cancer surgery at hospitals that perform a small volume of these procedures. However, these studies have not examined cancer-specific outcomes. Contribution Among patients in a randomized trial of adjuvant chemotherapy, lower long-term survival at low-volume hospitals was not due to higher rates of colorectal cancer recurrence or cancer-specific death. Implications Poor long-term survival in hospitals with low rates of colorectal cancer surgery may be due to the poor general health of populations cared for at low-volume hospitals rather than to low-quality cancer surgery. –The Editors

 

Author and Article Information

From Dana-Farber Cancer Institute, Eastern Cooperative Oncology Group Statistical Center, and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Memorial Sloan-Kettering Cancer Center and St. Vincent Clinical Cancer Center, New York, New York; University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania; and Northwestern University, Chicago, Illinois.

Acknowledgments: The authors thank Shandi Smith and Trong Ao for their assistance in data collection and Mike Hadad for his help in compiling Medicare volume data.

Grant Support: Dr. Meyerhardt is supported in part by a K07 award from the National Cancer Institute (1K07CA097992-01A1) and an American Society of Clinical Oncology career development award.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jeffrey A. Meyerhardt, MD, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.

Current Author Addresses: Drs. Meyerhardt, Catalano, Mayer, and Fuchs: Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.

Dr. Schrag: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 221, New York, NY 10021.

Dr. Ayanian: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Haller: University of Pennsylvania Cancer Center, 3400 Spruce Street, 16 Penn Tower, Philadelphia, PA 19104-4204.

Dr. Macdonald: St. Vincent's Comprehensive Cancer Center, 325 West 15th Street, New York, NY 10011.

Dr. Benson: Northwestern University, 676 North St. Clair Street, Suite 850, Chicago, IL 60611.

Author Contributions: Conception and design: J.A. Meyerhardt, P.J. Catalano, J.Z. Ayanian, D.G. Haller, R.J. Mayer, J.S. Macdonald, C.S. Fuchs.

Analysis and interpretation of the data: J.A. Meyerhardt, P.J. Catalano, D. Schrag, J.Z. Ayanian, C.S. Fuchs.

Drafting of the article: J.A. Meyerhardt, D. Schrag, C.S. Fuchs.

Critical revision of the article for important intellectual content: J.A. Meyerhardt, D. Schrag, J.Z. Ayanian, D.G. Haller, R.J. Mayer, A.B. Benson III.

Final approval of the article: J.A. Meyerhardt, P.J. Catalano, D. Schrag, J.Z. Ayanian, D.G. Haller, R.J. Mayer, J.S. Macdonald, A.B. Benson III, C.S. Fuchs.

Provision of study materials or patients: J.A. Meyerhardt, D.G. Haller, R.J. Mayer, J.S. Macdonald, A.B. Benson III.

Statistical expertise: J.A. Meyerhardt, P.J. Catalano, C.S. Fuchs.

Obtaining of funding: J.A. Meyerhardt, C.S. Fuchs.

Administrative, technical, or logistic support: P.J. Catalano.

Collection and assembly of the data: J.A. Meyerhardt.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Facebook

Reddit

Technorati

Twitter

Related articles in Annals:

Articles
The Effect of Clustering of Outcomes on the Association of Procedure Volume and Surgical Outcomes
Katherine S. Panageas, Deborah Schrag, Elyn Riedel, Peter B. Bach, AND Colin B. Begg

Annals 2003 139: 658-665. [ABSTRACT][SUMMARY][Full Text]  

Editorials
Does Practice Really Make Perfect?
Christine Laine AND Harold C. Sox

Annals 2003 139: 696-698. [Full Text]  

Summaries for Patients
Relationships between the Amount of Colon Cancer Surgery a Hospital Performs and Patient Outcomes

Annals 2003 139: I-28. [Full Text]  

Letters
Hospital Procedure Volume and Outcomes
Ashish V. Joshi AND Lesley-Ann Miller

Annals 2004 140: 1061-1062. [Full Text]  

Letters
Hospital Procedure Volume and Outcomes
Jeffrey A. Meyerhardt AND Charles S. Fuchs

Annals 2004 140: 1062. [Full Text]  

Letters
Correction: Hospital Procedure Volume and Outcomes

Annals 2004 140: 1063. [Full Text]  

This article has been cited by other articles:

				R. L. Gruen, V. Pitt, S. Green, A. Parkhill, D. Campbell, and D. Jolley The Effect of Provider Case Volume on Cancer Mortality: Systematic Review and Meta-Analysis CA Cancer J Clin, May 1, 2009; 59(3): 192 - 211. [Abstract] [Full Text] [PDF]

				A. B. Nattinger, P. W. Laud, R. A. Sparapani, X. Zhang, J. M. Neuner, and M. A. Gilligan Exploring the Surgeon Volume Outcome Relationship Among Women With Breast Cancer Arch Intern Med, October 8, 2007; 167(18): 1958 - 1963. [Abstract] [Full Text] [PDF]

				M. A. Gilligan, J. Neuner, X. Zhang, R. Sparapani, P. W. Laud, and A. B. Nattinger Relationship Between Number of Breast Cancer Operations Performed and 5-Year Survival After Treatment for Early-Stage Breast Cancer Am J Public Health, March 1, 2007; 97(3): 539 - 544. [Abstract] [Full Text] [PDF]

				W. P. Weber, U. Guller, N. B. Jain, R. Pietrobon, and D. Oertli Impact of Surgeon and Hospital Caseload on the Likelihood of Performing Laparoscopic vs Open Sigmoid Resection for Diverticular Disease: A Study Based on 55 949 Patients Arch Surg, March 1, 2007; 142(3): 253 - 259. [Abstract] [Full Text] [PDF]

				K. Khan, A. Campbell, T. Wallington, and M. Gardam The impact of physician training and experience on the survival of patients with active tuberculosis. Can. Med. Assoc. J., September 26, 2006; 175(7): 749 - 753. [Abstract] [Full Text] [PDF]

				H.-C. Lin, S. Xirasagar, H.-C. Lee, and C.-Y. Chai Hospital Volume and Inpatient Mortality After Cancer-Related Gastrointestinal Resections: The Experience of an Asian Country Ann. Surg. Oncol., September 1, 2006; 13(9): 1182 - 1188. [Abstract] [Full Text] [PDF]

				R. M. Goldberg, D. Niedzwiecki, M. Bertagnolli, A. W. Blackstock, J. E. Tepper, and R. J. Mayer Cancer and leukemia group B gastrointestinal cancer committee. Clin. Cancer Res., June 1, 2006; 12(11): 3589s - 3595s. [Abstract] [Full Text] [PDF]

				D. Schrag, C. Earle, F. Xu, K. S. Panageas, K. R. Yabroff, R. E. Bristow, E. L. Trimble, and J. L. Warren Associations Between Hospital and Surgeon Procedure Volumes and Patient Outcomes After Ovarian Cancer Resection J Natl Cancer Inst, February 1, 2006; 98(3): 163 - 171. [Abstract] [Full Text] [PDF]

				D. G. Haller, P. J. Catalano, J. S. Macdonald, M. A. O'Rourke, M. S. Frontiera, D. V. Jackson, and R. J. Mayer Phase III Study of Fluorouracil, Leucovorin, and Levamisole in High-Risk Stage II and III Colon Cancer: Final Report of Intergroup 0089 J. Clin. Oncol., December 1, 2005; 23(34): 8671 - 8678. [Abstract] [Full Text] [PDF]

				B. K. Edwards, M. L. Brown, P. A. Wingo, H. L. Howe, E. Ward, L. A. G. Ries, D. Schrag, P. M. Jamison, A. Jemal, X. C. Wu, et al. Annual Report to the Nation on the Status of Cancer, 1975-2002, Featuring Population-Based Trends in Cancer Treatment J Natl Cancer Inst, October 5, 2005; 97(19): 1407 - 1427. [Abstract] [Full Text] [PDF]

				A. Zaniboni and R. Labianca Adjuvant therapy for stage II colon cancer: an elephant in the living room? Ann. Onc., September 1, 2004; 15(9): 1310 - 1318. [Abstract] [Full Text] [PDF]

				Correction: Hospital Procedure Volume and Outcomes Ann Intern Med, June 15, 2004; 140(12): 1063 - 1063. [Full Text] [PDF]

				A. V. Joshi and L.-A. Miller Hospital Procedure Volume and Outcomes Ann Intern Med, June 15, 2004; 140(12): 1061 - 1062. [Full Text] [PDF]

				Association Between Procedure Volume and Patient Outcome Is Challenged Journal Watch Gastroenterology, November 12, 2003; 2003(1112): 3 - 3. [Full Text]

				C. Laine and H. C. Sox Does Practice Really Make Perfect? Ann Intern Med, October 21, 2003; 139(8): 696 - 698. [Full Text] [PDF]