Robert E Bristow1, Jenny Chang, Argyrios Ziogas, Hoda Anton-Culver. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, California; and the Department of Epidemiology, University of California, Irvine, Irvine, California.
Abstract
OBJECTIVES: To validate National Comprehensive Cancer Network ovarian cancer guideline adherence as a quality process measure associated with improved survival, and to identify structural health care characteristics predictive of adherence to National Comprehensive Cancer Network guideline care. METHODS: Consecutive patients with epithelial ovarian cancer diagnosed between 1 January 1999 and 31 December 2006 were identified from the California Cancer Registry. Adherence to National Comprehensive Cancer Network guideline care was defined by stage-appropriate surgical procedures and recommended chemotherapy. Multivariable logistic regression models were used to identify characteristics predictive of National Comprehensive Cancer Network guideline adherence and ovarian cancer-specific survival. RESULTS: A total of 13,321 patients were identified. Overall, 37.2% of patients received National Comprehensive Cancer Network guideline-adherent care. Guideline-adherent care was associated with high-volume hospitals (20 or more cases per year; 50.8% compared with 34.1%; P<.001) and high-volume physicians (10 or more cases per year; 47.6% compared with 34.5%; P<.001). After controlling for other factors, both low-volume hospitals (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.66-2.01) and low-volume physicians (OR 1.19, 95% CI 1.07-1.32) were independently associated with deviation from National Comprehensive Cancer Network guidelines. On multivariable survival analysis, nonadherence to National Comprehensive Cancer Network guideline care was associated with decreased disease-specific survival (hazard ratio [HR] 1.33, 95% CI 1.26-1.41). Both low-volume hospitals (HR 1.08, 95% CI 1.01-1.16) and low-volume physicians (HR 1.18, 95% CI 1.09-1.28) were associated with decreased disease-specific survival after adjusting for National Comprehensive Cancer Network guideline-adherent care. CONCLUSIONS: Adherence to National Comprehensive Cancer Network guidelines for treatment of ovarian cancer is correlated with improved survival and may be a useful process measure of quality cancer care. Ovarian cancer case volume correlates with a higher likelihood of recommended care and improved survival and may be a useful structural quality measure. Increased efforts to concentrate ovarian cancer care are warranted.
OBJECTIVES: To validate National Comprehensive Cancer Network ovarian cancer guideline adherence as a quality process measure associated with improved survival, and to identify structural health care characteristics predictive of adherence to National Comprehensive Cancer Network guideline care. METHODS: Consecutive patients with epithelial ovarian cancer diagnosed between 1 January 1999 and 31 December 2006 were identified from the California Cancer Registry. Adherence to National Comprehensive Cancer Network guideline care was defined by stage-appropriate surgical procedures and recommended chemotherapy. Multivariable logistic regression models were used to identify characteristics predictive of National Comprehensive Cancer Network guideline adherence and ovarian cancer-specific survival. RESULTS: A total of 13,321 patients were identified. Overall, 37.2% of patients received National Comprehensive Cancer Network guideline-adherent care. Guideline-adherent care was associated with high-volume hospitals (20 or more cases per year; 50.8% compared with 34.1%; P<.001) and high-volume physicians (10 or more cases per year; 47.6% compared with 34.5%; P<.001). After controlling for other factors, both low-volume hospitals (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.66-2.01) and low-volume physicians (OR 1.19, 95% CI 1.07-1.32) were independently associated with deviation from National Comprehensive Cancer Network guidelines. On multivariable survival analysis, nonadherence to National Comprehensive Cancer Network guideline care was associated with decreased disease-specific survival (hazard ratio [HR] 1.33, 95% CI 1.26-1.41). Both low-volume hospitals (HR 1.08, 95% CI 1.01-1.16) and low-volume physicians (HR 1.18, 95% CI 1.09-1.28) were associated with decreased disease-specific survival after adjusting for National Comprehensive Cancer Network guideline-adherent care. CONCLUSIONS: Adherence to National Comprehensive Cancer Network guidelines for treatment of ovarian cancer is correlated with improved survival and may be a useful process measure of quality cancer care. Ovarian cancer case volume correlates with a higher likelihood of recommended care and improved survival and may be a useful structural quality measure. Increased efforts to concentrate ovarian cancer care are warranted.
Authors: Jason D Wright; Yongmei Huang; Alexander Melamed; Ana I Tergas; Caryn M St Clair; June Y Hou; Fady Khoury-Collado; Cande V Ananth; Alfred I Neugut; Dawn L Hershman Journal: Obstet Gynecol Date: 2019-06 Impact factor: 7.661
Authors: Robert E Bristow; Jenny Chang; Argyrios Ziogas; Daniel L Gillen; Lu Bai; Veronica M Vieira Journal: Am J Obstet Gynecol Date: 2015-01-31 Impact factor: 8.661
Authors: Robert E Bristow; Jenny Chang; Argyrios Ziogas; Belinda Campos; Leo R Chavez; Hoda Anton-Culver Journal: J Am Coll Surg Date: 2015-02-14 Impact factor: 6.113
Authors: Alba A Brandes; Enrico Franceschi; Mario Ermani; Alicia Tosoni; Fiorenzo Albani; Roberta Depenni; Marina Faedi; Anna Pisanello; Girolamo Crisi; Benedetta Urbini; Claudio Dazzi; Luigi Cavanna; Claudia Mucciarini; Giuseppe Pasini; Stefania Bartolini; Gianluca Marucci; Luca Morandi; Elena Zunarelli; Serenella Cerasoli; Giorgio Gardini; Giovanni Lanza; Enrico Maria Silini; Silvio Cavuto; Agostino Baruzzi; A Baruzzi; F Albani; F Calbucci; R D'Alessandro; R Michelucci; A Brandes; V Eusebi; S Ceruti; E Fainardi; R Tamarozzi; E Emiliani; M Cavallo; E Franceschi; A Tosoni; M Cavallo; F Fiorica; A Valentini; R Depenni; C Mucciarini; G Crisi; E Sasso; C Biasini; L Cavanna; D Guidetti; N Marcello; A Pisanello; A M Cremonini; G Guiducci; S de Pasqua; S Testoni; R Agati; G Ambrosetto; A Bacci; E Baldin; A Baldrati; E Barbieri; S Bartolini; E Bellavista; F Bisulli; E Bonora; F Bunkheila; V Carelli; M Crisci; P Dall'Occa; D de Biase; S Ferro; C Franceschi; G Frezza; V Grasso; M Leonardi; G Marucci; V Mazzocchi; L Morandi; B Mostacci; G Palandri; E Pasini; M Pastore Trossello; A Pession; M Ragazzi; P Riguzzi; R Rinaldi; S Rizzi; G Romeo; F Spagnolli; P Tinuper; C Trocino; S Cerasoli; M Dall'Agata; M Faedi; M Frattarelli; G Gentili; A Giovannini; P Iorio; U Pasquini; G Galletti; C Guidi; W Neri; A Patuelli; S Strumia; M Casmiro; A Gamboni; F Rasi; G Cruciani; P Cenni; C Dazzi; Ar Guidi; F Zumaglini; A Amadori; G Pasini; M Pasquinelli; E Pasquini; A Polselli; A Ravasio; B Viti; M Sintini; A Ariatti; F Bertolini; G Bigliardi; P Carpeggiani; F Cavalleri; S Meletti; P Nichelli; E Pettorelli; G Pinna; E Zunarelli; F Artioli; I Bernardini; M Costa; G Greco; R Guerzoni; C Stucchi; C Iaccarino; R Rizzi; G Zuccoli; P Api; F Cartei; E Fallica; E Granieri; F Latini; G Lelli; C Monetti; V Ramponi; A Saletti; R Schivalocchi; S Seraceni; M R Tola; B Urbini; C Giorgi; E Montanari; D Cerasti; P Crafa; I Dascola; I Florindo; S Mazza; F Servadei; Em Silini; P Torelli; P Immovilli; N Morelli; C Vanzo Journal: Neurooncol Pract Date: 2014-08-28
Authors: Renee A Cowan; Roisin E O'Cearbhaill; Ginger J Gardner; Douglas A Levine; Kara Long Roche; Yukio Sonoda; Oliver Zivanovic; William P Tew; Evis Sala; Yulia Lakhman; Hebert A Vargas Alvarez; Debra M Sarasohn; Svetlana Mironov; Nadeem R Abu-Rustum; Dennis S Chi Journal: Ann Surg Oncol Date: 2015-10-28 Impact factor: 5.344