title: Impact of facility volume on therapy and survival for locally advanced cervical cancer.
abstract: OBJECTIVE
  Chemosensitizing radiation with brachytherapy is standard of care for treatment of locally advanced cervical cancer, an increasingly rare disease. Treatment facility volume has been correlated with outcome in many diseases. Treatment outcome and likelihood of receiving standard therapy in locally advanced cervical cancer based on facility volume were examined using a large national cancer database.
  
  
  METHODS
  The National Cancer Data Base was queried for patients with stage IIB - IIIB cervical cancer from 1/1998 through 12/2010. Facility volumes were tallied. Overall survival was estimated using Kaplan-Meier method. Univariate and multivariable analyses were performed to determine variables affecting survival, receiving standard therapy, and total duration of radiotherapy.
  
  
  RESULTS
  We identified a total of 27,660 patients who were treated at 1361 facilities. Thirty of the facilities (2.2%) treated the highest quartile volume of patients (>9.4 patients annually) while 1072 facilities (78.8%) treated <2.4 patients annually. The median age of patients was 53, the majority were Caucasian, treated in a metropolitan area, and of squamous cell histology. Median survival of patients treated at lowest- and highest-volume centers were 42.3 months (95% CI 39.8-44.8) and 53.8 months (50.1-57.5), respectively (p < 0.001). The proportions of patients receiving brachytherapy and chemotherapy were 54.8% and 79.9%, respectively. On multivariable analysis, higher facility volume independently predicted improved survival (p = 0.022), increased likelihood of receiving brachytherapy (p < 0.0005) and chemotherapy (p = 0.013), and shorter time to radiotherapy completion (p < 0.0005).
  
  
  CONCLUSIONS
  Patients with locally advanced cervical cancer treated at high volume centers are more likely to receive standard therapy, complete therapy sooner, and experience better survival.
authors: Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA. Electronic address: linjf@upmc.edu.
authors: Jeff F
authors: JF
authors: Lin
authors: Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
authors: Jessica L
authors: JL
authors: Berger
authors: Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA; Western Pennsylvania Hospital, Pittsburgh, PA, USA.
authors: Thomas C
authors: TC
authors: Krivak
authors: Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
authors: Sushil
authors: S
authors: Beriwal
authors: University of California- San Francisco, San Francisco, CA, USA.
authors: John K
authors: JK
authors: Chan
authors: Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA.
authors: Paniti
authors: P
authors: Sukumvanich
authors: St. Joseph's Hospital and Medical Center, Creighton University School of Medicine, Phoenix, AZ, USA; University of Arizona Cancer Center, Phoenix, AZ, USA.
authors: Bradley J
authors: BJ
authors: Monk
authors: Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA.
authors: Scott D
authors: SD
authors: Richard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D002173:Cancer Care Facilities / Q000592:standards / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011787:Quality of Health Care; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000628:therapy*; D055815:Young Adult
chemical_list: D011838:Radiation-Sensitizing Agents
keywords: Cervical cancer; Healthcare outcomes; National cancer database; Quality of care