title: Influence of department volume on cancer survival for gynaecological cancers--a population-based study in Tyrol, Austria.
abstract: OBJECTIVE
  The objective of this study was to assess the effect of department volume on survival of patients with gynaecological cancer.
  
  
  METHODS
  We conducted an observational population-based study in Tyrol, Austria. The analysis includes all patient data on incident gynaecological cancer collected by the Cancer Registry of Tyrol. Data were collected since 1988 on a population-based perspective; publication of incidence data since 1988 in Cancer Incidence in Five Continents gives evidence for good completeness and validity of the database. Patient survival status is assessed in a passive way by probabilistic record linkage between incidence data and official mortality data. We applied a multivariate Cox regression with variables age, sex, stage, year of diagnosis, histological verification of diagnosis, transfer to other hospital and department volume. Department volume was categorised in < or = 11/12-23/24-35/ > or = 36 patients per year reflecting one/two/three/more than three patients per month; categories were computed separately for every site we analysed. Departments with up to 11 patients per year were called small departments.
  
  
  RESULTS
  For 4,191 breast cancer patients, we found a negative effect for small departments; hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.22, 1.58. For ovarian cancer patients, we also found a negative effect for small departments (HR 1.27, 95% CI 1.05, 1.54). For cervical cancer patients, we found a positive effect for small departments (HR 0.67, 95% CI 0.51, 0.88). No effect was shown for corpus cancer (HR 0.80, 95% CI 0.63, 1.01).
  
  
  CONCLUSIONS
  The results indicate that, in our country, rules on minimum department case-load can further improve survival for breast and ovarian cancer patients.
authors.affiliation: Cancer Registry of Tyrol, Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd, Innsbruck, Austria. willi.oberaigner@iet.at
authors.forename: Willi
authors.initials: W
authors.lastname: Oberaigner
authors.forename: Wolf
authors.initials: W
authors.lastname: Stühlinger
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016522:Oncology Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data*