Is cancer care best at high-volume providers?
For a variety of medical conditions and procedures, a higher volume-better outcome relationship has been hypothesized for over 25 years. An extensive, consistent body of literature supports a relationship between hospital volume and short-term outcomes for cancers treated with technologically complex surgical procedures. For cancer primarily treated by low-risk surgery, there are few studies. Recent studies found a modest (about 2%) difference in survival benefit between high-volume and low-volume providers associated with colon cancer surgery. Few evaluations in the last 15 years have addressed nonsurgical cancers, eg, lymphomas and testicular cancer. No reports have addressed recurrent or metastatic cancer. Care is better at high-volume providers for a select minority of cancers. Whether provider volume matters in the majority of cancers at the time of presentation has not been evaluated.
Hillner
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Massey Cancer Center, Department of Internal Medicine, Medical College of Virginia at Virginia Commonwealth University, Box 980170, Richmond, VA 23298-0170, USA. hillner@hsc.vcu.edu
D002173:Cancer Care Facilities / Q000592:standards* / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D009369:Neoplasms / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care