Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival

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Abstract

Objective To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. Methods We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006 to 2012. Inclusion criteria were treatment at a high volume hospital (> 20 cases/year) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. Results We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n = 2494) of patients and use varied widely by hospital, from 5%–55%. High utilization hospitals (n = 1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23–55%), while low utilization hospitals (n = 2671, 14 hospitals) had a median rate of 10% (range 5–17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95% CI 0.83–0.97 and HR 0.85 95% CI 0.75–0.95). Conclusions Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival.

LanguageEnglish (US)
Pages500-507
Number of pages8
JournalGynecologic oncology
Volume145
Issue number3
DOIs
StatePublished - Jun 1 2017

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High-Volume Hospitals
Drug Therapy
Survival
Ovarian epithelial cancer
Logistic Models
Diagnosis-Related Groups
Therapeutics
Survival Analysis
Ovarian Neoplasms
Comorbidity

Keywords

  • Hospital utilization
  • Neoadjuvant chemotherapy
  • Ovarian cancer
  • Patterns of care

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

@article{109a84290fbe497888b14da6f845e261,
title = "Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival",
abstract = "Objective To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. Methods We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006 to 2012. Inclusion criteria were treatment at a high volume hospital (> 20 cases/year) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. Results We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6{\%} (n = 2494) of patients and use varied widely by hospital, from 5{\%}–55{\%}. High utilization hospitals (n = 1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39{\%} (range 23–55{\%}), while low utilization hospitals (n = 2671, 14 hospitals) had a median rate of 10{\%} (range 5–17{\%}). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95{\%} CI 0.83–0.97 and HR 0.85 95{\%} CI 0.75–0.95). Conclusions Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival.",
keywords = "Hospital utilization, Neoadjuvant chemotherapy, Ovarian cancer, Patterns of care",
author = "Barber, {Emma L.} and Dusetzina, {Stacie B.} and Stitzenberg, {Karyn B.} and Rossi, {Emma C.} and Gehrig, {Paola A.} and Boggess, {John F.} and Garrett, {Joanne M.}",
year = "2017",
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doi = "10.1016/j.ygyno.2017.03.014",
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volume = "145",
pages = "500--507",
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T1 - Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival

AU - Barber,Emma L.

AU - Dusetzina,Stacie B.

AU - Stitzenberg,Karyn B.

AU - Rossi,Emma C.

AU - Gehrig,Paola A.

AU - Boggess,John F.

AU - Garrett,Joanne M.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objective To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. Methods We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006 to 2012. Inclusion criteria were treatment at a high volume hospital (> 20 cases/year) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. Results We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n = 2494) of patients and use varied widely by hospital, from 5%–55%. High utilization hospitals (n = 1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23–55%), while low utilization hospitals (n = 2671, 14 hospitals) had a median rate of 10% (range 5–17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95% CI 0.83–0.97 and HR 0.85 95% CI 0.75–0.95). Conclusions Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival.

AB - Objective To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. Methods We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006 to 2012. Inclusion criteria were treatment at a high volume hospital (> 20 cases/year) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. Results We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n = 2494) of patients and use varied widely by hospital, from 5%–55%. High utilization hospitals (n = 1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23–55%), while low utilization hospitals (n = 2671, 14 hospitals) had a median rate of 10% (range 5–17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95% CI 0.83–0.97 and HR 0.85 95% CI 0.75–0.95). Conclusions Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival.

KW - Hospital utilization

KW - Neoadjuvant chemotherapy

KW - Ovarian cancer

KW - Patterns of care

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U2 - 10.1016/j.ygyno.2017.03.014

DO - 10.1016/j.ygyno.2017.03.014

M3 - Article

VL - 145

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EP - 507

JO - Gynecologic Oncology

T2 - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

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