ASPO Abstracts
Hospital Quality and Ovarian Cancer Survival in the Nurses’ Health Studies
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research, Cancer Health Disparities
Conference Year: 2018
Abstract Body:
Use of National Comprehensive Cancer Network treatment guidelines for ovarian cancer is related to improved survival, and treatment at an NCI Comprehensive Cancer Center (NCI-CCC) or by a gynecologic oncologist are independent predictors of guideline adherence. Our aim was to assess the association between type of hospital where primary cytoreductive surgery was performed and survival among ovarian cancer patients in a population- based study of women living across the US. We pooled two prospective cohorts of registered nurses, the Nurses’ Health Study (NHS), initiated in 1976, and NHSII, initiated in 1989. Eligible ovarian cancer cases were diagnosed after enrollment and had data on hospital of primary surgery. Hospitals were categorized by type (NCI-CCC, academic hospital, community hospital) and by presence/absence of a gynecologic oncology fellowship program (as a marker for access to specialist care). We used Cox proportional hazards models to estimate relative risks (RR) and 95% confidence intervals (CI) for ovarian cancer-specific mortality adjusting for age, histologic subtype, morphology, stage and cohort. In total, 1,084 ovarian cancer cases were diagnosed through 2014. The majority (62.6%) had initial surgery at a community hospital, 14.9% were seen at an NCI-CCC, 19.4% at an academic center, and 3.1% were not unclassifiable; 15.0% were seen at a center with a fellowship program. Compared to a community hospital, cases who sought care at an NCI-CCC had a suggestively lower risk of death (RR=0.82, 95%CI=0.67-1.02), but no association was observed for academic hospitals (RR=0.96). Similarly, compared to community hospitals, there was suggestively improved survival (RR=0.87, 95%CI=0.70-1.07) for cases seen at a center with a gynecologic oncology fellowship program that was more apparent for women with non-serous (RR=0.69) versus serous tumors (RR=0.96). Despite the health background of this population, few ovarian cancer cases sought care at high-volume centers or centers with specialist care, which was suggestively associated with improved survival, particularly for non-serous histotypes in this geographically dispersed population. More research considering surgical outcomes and other populations is warranted.
Keywords: Ovarian Cancer Survival Hospital type