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

  1. Jeffrey A. Meyerhardt, MD;
  2. Paul J. Catalano, ScD;
  3. Deborah Schrag, MD, MPH;
  4. John Z. Ayanian, MD, MPP;
  5. Daniel G. Haller, MD;
  6. Robert J. Mayer, MD;
  7. John S. Macdonald, MD;
  8. Al B. Benson III, MD; and
  9. Charles S. Fuchs, MD, MPH
  1. 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.

    Abstract

    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.

    Article and Author Information

    • 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.

    Summary for Patients

    • Summaries for Patients:Relationships between the Amount of Colon Cancer Surgery a Hospital Performs and Patient Outcomes Ann Intern Med October 21, 2003 139:I-28
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    1. Ann Intern Med October 21, 2003 vol. 139 no. 8 649-657
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