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The Effect of Hospital Volume on Breast Cancer Mortality
Rachel A Greenup1,2, Samilia Obeng-Gyasi3, Samantha Thomas2
1Duke University Medical Center, Durham, North Carolina.
Annals of Surgery
|November 29, 2016
Summary
Treatment at high-volume breast cancer centers significantly reduces overall mortality. High case volume may indicate better institutional infrastructure for complex cancer care, improving patient survival.
Area of Science:
- Oncology
- Health Services Research
- Epidemiology
Background:
- Prior studies indicate improved survival for rare, complex cancers treated at high-volume centers.
- The impact of hospital volume on breast cancer survival remains an area for further investigation.
Purpose of the Study:
- To investigate the association between hospital volume and breast cancer patient mortality.
- To identify specific case volume thresholds influencing breast cancer survival rates.
Main Methods:
- Analysis of over 1 million adult breast cancer patients (Stages 0-III) from the National Cancer Data Base (2004-2012).
- Utilized multivariable Cox proportional hazards models with restricted cubic splines to assess hospital volume's impact on overall survival.
- Categorized hospitals into low (<148 cases/year), moderate (148-298 cases/year), and high (>298 cases/year) volume groups.
Main Results:
- High-volume centers ( >298 cases/year) were associated with an 11% reduction in overall mortality (HR 0.89).
- Patients with Stage 0-I, ER+/PR+, or ER+/PR- breast cancer experienced the most significant survival benefits at high-volume centers.
- A total of 1,064,251 patients were included in the analysis.
Conclusions:
- Treatment at high-volume centers is linked to improved survival for breast cancer patients across all stages.
- High hospital case volume may serve as a surrogate marker for advanced institutional infrastructure supporting comprehensive breast cancer care.
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