Synapse - Impact of provider volume on front-line chemotherapy guideline compliance and overall survival in elderly patients with advanced ovarian cancer

Impact of provider volume on front-line chemotherapy guideline compliance and overall survival in elderly patients with advanced ovarian cancer Journal Article

Authors:	Aviki, E. M.; Lavery, J. A.; Long Roche, K.; Cowan, R.; Dessources, K.; Basaran, D.; Green, A. K.; Aghajanian, C. A.; O'Cearbhaill, R.; Jewell, E. L.; Leitao, M. M. Jr; Gardner, G. J.; Abu-Rustum, N. R.; Sabbatini, P.; Bach, P. B.
Article Title:	Impact of provider volume on front-line chemotherapy guideline compliance and overall survival in elderly patients with advanced ovarian cancer
Abstract:	Purpose: We sought to evaluate whether provider volume or other factors are associated with chemotherapy guideline compliance in elderly patients with epithelial ovarian cancer (EOC). Methods: We queried the SEER-Medicare database for patients ≥66 years, diagnosed with FIGO stage II-IV EOC from 2004 to 2013 who underwent surgery and received chemotherapy within 7 months of diagnosis. We compared NCCN guideline compliance (6 cycles of platinum-based doublet) and chemotherapy-related toxicities across provider volume tertiles. Factors associated with guideline compliance and chemotherapy-related toxicities were assessed using logistic regression. Overall survival (OS) was compared across volume tertiles and Cox proportional-hazards model was created to adjust for case-mix. Results: 1924 patients met inclusion criteria. The overall rate of guideline compliance was 70.3% with a significant association between provider volume and compliance (64.5% for low-volume, 72.2% for medium-volume, 71.7% for high-volume, p = .02). In the multivariate model, treatment by low-volume providers and patient age ≥ 80 years were independently associated with worse chemotherapy-guideline compliance. In the survival analysis, there was a significant difference in median OS across provider volume tertiles with median survival of 32.8 months (95%CI 29.6, 36.4) low-volume, 41.9 months (95%CI 37.5, 46.7) medium-volume, 42.1 months (95%CI 38.8, 44.2) high-volume providers, respectively (p < .01). After adjusting for case-mix, low-volume providers were independently associated with higher rates of mortality (aHR 1.25, 95%CI: 1.08, 1.43). Conclusions: In a modern cohort of elderly Medicare patients with advanced EOC, we found higher rates of non-compliant care and worse survival associated with treatment by low-volume Medicare providers. Urgent efforts are needed to address this volume-outcomes disparity. © 2020 Elsevier Inc.
Keywords:	chemotherapy; ovarian cancer; treatment outcomes; provider volume; guideline compliance
Journal Title:	Gynecologic Oncology
Volume:	159
Issue:	2
ISSN:	0090-8258
Publisher:	Elsevier Inc.
Date Published:	2020-11-01
Start Page:	418
End Page:	425
Language:	English
DOI:	10.1016/j.ygyno.2020.07.104
PUBMED:	32814642
PROVIDER:	scopus
PMCID:	PMC8436488
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85089454056&doi=10.1016%2fj.ygyno.2020.07.104&partnerID=40&md5=48b9f0efb117aaf7cb91de22d85f71ca
Notes:	Article -- Export Date: 2 November 2020 -- Source: Scopus