Researchers from Finland have reported that low hospital volume is associated with residual tumor in women with ovarian cancer. The details of this study appeared in the November, 2009 issue of Gynecologic Oncology.[1] 

For several types of cancer, a large and growing body of evidence has demonstrated improved outcomes for patients treated by surgeons who perform a high volume of specialized surgeries and for patients who are treated in a hospital with a high volume of patients undergoing a specific procedure.

Researchers from the Netherlands have reported that overall survival of patients with ovarian cancer was better in hospitals with two or more medical oncologists and in hospitals with a high volume of patients with ovarian cancer.[2] Researchers from the Johns Hopkins University have reported that “ovarian cancer surgery performed by a high-volume surgeon is associated with a 69% reduction in the risk of in-hospital death, while high-volume hospital care is associated with increased likelihood of cytoreduction, shorter length of stay, and lower hospital-related cost of care.”[3]

The current study grew out of the observation that, in Finland, women with ovarian cancer had better surgical outcomes if treated in University hospitals compared with other hospitals.  They then categorized hospitals by the number of operations performed for ovarian cancer in 1999 into three groups: <10, 10-20, or >20 operations. These data included 90% of patients with epithelial ovarian cancer in Finland in 1999. Eighty-two percent of patients in this analysis received platinum-based chemotherapy. They made the following observations:

• 63% of patients treated in University hospitals received platinum and taxane therapy compared with 49% of women treated in other hospitals.
• For all patients the cancer-specific survival was 56% and the median disease-free survival was 33 months.
• Good prognostic features for cancer-specific survival included stage, residual tumor, and primary chemotherapy.
• Higher hospital volume was associated with a lower incidence of residual tumor. As the volume of patients treated per year increased, the number of patients with residual disease decreased.

These authors concluded: “FIGO stage, residual tumor, and primary chemotherapy are important prognostic factors for ovarian cancer. Hospital volume is associated with residual tumor. The results favor performance of ovarian cancer surgery in hospitals with higher operative volume.”

Comments: These data are consistent with other studies showing that complicated cancer treatment is best performed in high-volume hospitals with high-volume surgeons. This message appears to be getting across to the public. Researchers from Johns Hopkins have recently reported, “The proportions of ovarian cancer patients undergoing primary surgery at high volume centers and by high-volume surgeons increased statistically significantly from 1990-2000 to 2001-2008.” [4]

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