[Estimation of the effects of centralization of cancer treatment on mortality reduction by in Fukui Prefecture].
OBJECTIVE
This study was conducted to clarify the efficacy of centralization of cancer treatment using population-based cancer registry data in Fukui prefecture, Japan.


METHODS
Associations between hospital procedure volume and cancer survival were analyzed using the population-based cancer registry survival data for Fukui prefecture between 1994 and 1998. Firstly the cancer patients who received primary treatments for each target sites such as esophagus, stomach, colon, liver, gall bladder, pancreas, lung, breast, uterus, ovary, prostate, urinary bladder, and lymphoid tissue were totaled. Then, hospitals were divided into 4 categories according to the number of patients by each site; high, medium, low and very low volume. Stage-matched 5-year relative survival rates for each site were then calculated for each categorized hospital volume, and that most desirable for medical treatment for each target site was decided with reference to age-, sex-, and cancer stage-adjusted hazard ratios. Age-adjusted morality reduction was estimated by the expected survival rate after centralization when all cancer patients had received treatments.


RESULTS
The 5-year relative survival rates were higher in hospitals with large numbers of patients. With some target sites, such as the stomach, colon, and breast, the mortality was similar between high and low volume hospitals, whereas the other target sites showed higher mortality in line with decrease in number of patients treated. It was estimated that a 2.06% reduction in the mortality rate might be achieved if each case were treated at the most desirable category of hospital in Fukui prefecture.


CONCLUSIONS
Cancer treatment at hospitals have appropriate procedure volumes is an effective way to increase cancer survival and lower the mortality rate.
Hattori
Masakazu
M
Fukui Prefectural Hospital.
Fujita
Manabu
M
Nakamura
Yosikazu
Y
Ioka
Akiko
A
D005260:Female; D006285:Health Planning / Q000379:methods*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D015996:Survival Rate; D016526:Workload