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
DOI/URL:
Notes: Article -- Export Date: 2 November 2020 -- Source: Scopus
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MSK Authors
  1. Ginger J Gardner
    203 Gardner
  2. Elizabeth Jewell
    96 Jewell
  3. Mario Leitao
    434 Leitao
  4. Paul J Sabbatini
    240 Sabbatini
  5. Kara Christine Long
    137 Long
  6. Peter Bach
    243 Bach
  7. Renee Antonette Woodburn Cowan
    30 Cowan
  8. Emeline Mariam Aviki
    32 Aviki
  9. Angela Kellen Green
    17 Green
  10. Jessica Ann Lavery
    40 Lavery
  11. Derman Basaran
    11 Basaran