Robert E. Bristow, MD
An analysis of more than 13,000 patients with ovarian cancer found that women were 30% less likely to die from the disease if the care they received followed the practice guidelines developed by the National Comprehensive Cancer Network (NCCN). However, the study also found that only around 37% of these patients receive care that adheres to the NCCN guidelines. Further, noncompliance with the NCCN standards was greatest at low-volume hospitals, indicating the need to improve patient-care methods at these facilities.
“This shows we have a lot of room to improve,” said Robert E. Bristow, MD, director of the Division of Gynecologic Oncology at the University of California, Irvine Medical Center, and lead author of the study, in a statement. “We need to become more sophisticated and to determine what the best performing physicians are doing different from everyone else, establish best practices and then enforce them to improve outcomes.”
The analysis included data from the California Cancer Registry on patients with epithelial ovarian cancer who underwent a minimum surgical procedure of oophorectomy between 1999 and 2006. Of the 13,321 patients for whom data were available, 18.8% were treated at hospitals that were considered “high-volume,” meaning that the facility saw at least 20 patients with ovarian cancer.
Overall, the analysis found that 37.2% of patients received treatment that adhered to the NCCN guidelines. High-volume hospitals were significantly more likely to deliver treatment that adhered to the NCCN guidelines (50.8%) compared with low-volume hospitals (34.1%; P
<.001). Additionally, high-volume surgeons were significantly more likely to deliver treatment that adhered to the guidelines (47.6%) than low-volume surgeons (34.5%; P
When the researchers performed a multivariate survival analysis controlling for patient, disease-related, and healthcare system factors, inferior overall survival was observed in patients whose treatment did not follow NCCN guidelines (hazard ratio [HR] = 1.34; 95% CI, 1.26-1.42). After adjusting for NCCN guideline adherence, the researchers found that low-volume hospitals (HR = 1.08; 95% CI, 1.01-1.16) and low-volume surgeons (HR = 1.18; 95% CI, 1.09-1.28) were independently associated with worse overall survival.
Bristow R, Chang J, Ziogas A, et al. NCCN treatment guidelines for ovarian cancer: a population-based validation study of structural and process quality measures. Presented at: 2013 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer; March 9-12, 2013; Los Angeles, CA. Abstract 45.