title: Impact of National Cancer Institute Comprehensive Cancer Centers on ovarian cancer treatment and survival.
abstract: BACKGROUND
  The regional impact of care at a National Cancer Institute Comprehensive Cancer Center (NCI-CCC) on adherence to National Comprehensive Cancer Network (NCCN) ovarian cancer treatment guidelines and survival is unclear.
  
  
  METHODS
  We performed a retrospective population-based study of consecutive patients diagnosed with epithelial ovarian cancer between January 1, 1996 and December 31, 2006 in southern California. Patients were stratified according to care at an NCI-CCC (n = 5), non-NCI high-volume hospital (≥ 10 cases/year, HVH, n = 29), or low-volume hospital (<10 cases/year, LVH, n = 158). Multivariable logistic regression and Cox-proportional hazards models were used to examine the effect of NCI-CCC status on treatment guideline adherence and ovarian cancer-specific survival.
  
  
  RESULTS
  A total of 9,933 patients were identified (stage I, 22.8%; stage II, 7.9%; stage III, 45.1%; stage IV, 24.2%), and 8.1% of patients were treated at NCI-CCCs. Overall, 35.7% of patients received NCCN guideline adherent care, and NCI-CCC status (odds ratio [OR] 1.00) was an independent predictor of adherence to treatment guidelines compared with HVHs (OR 0.83, 95% CI 0.70 to 0.99) and LVHs (OR 0.56, 95% CI 0.47 to 0.67). The median ovarian cancer-specific survivals according to hospital type were: NCI-CCC 77.9 (95% CI 61.4 to 92.9) months, HVH 51.9 (95% CI 49.2 to 55.7) months, and LVH 43.4 (95% CI 39.9 to 47.2) months (p < 0.0001). National Cancer Institute Comprehensive Cancer Center status (hazard ratio [HR] 1.00) was a statistically significant and independent predictor of improved survival compared with HVH (HR 1.18, 95% CI 1.04 to 1.33) and LVH (HR 1.30, 95% CI 1.15 to 1.47).
  
  
  CONCLUSIONS
  National Cancer Institute Comprehensive Cancer Center status is an independent predictor of adherence to ovarian cancer treatment guidelines and improved ovarian cancer-specific survival. These data validate NCI-CCC status as a structural health care characteristic correlated with superior ovarian cancer quality measure performance. Increased access to NCI-CCCs through regional concentration of care may be a mechanism to improve clinical outcomes.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine - School of Medicine, Irvine, CA. Electronic address: rbristow@uci.edu.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.affiliation: Department of Epidemiology, University of California, Irvine - School of Medicine, Irvine, CA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Epidemiology, University of California, Irvine - School of Medicine, Irvine, CA.
authors.forename: Argyrios
authors.initials: A
authors.lastname: Ziogas
authors.affiliation: University of California, Irvine - School of Social Sciences, Irvine, CA.
authors.forename: Belinda
authors.initials: B
authors.lastname: Campos
authors.affiliation: University of California, Irvine - School of Social Sciences, Irvine, CA.
authors.forename: Leo R
authors.initials: LR
authors.lastname: Chavez
authors.affiliation: Department of Epidemiology, University of California, Irvine - School of Medicine, Irvine, CA.
authors.forename: Hoda
authors.initials: H
authors.lastname: Anton-Culver
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002140:California; D002173:Cancer Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume / Q000592:standards / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy; D016015:Logistic Models; D008875:Middle Aged; D054547:National Cancer Institute (U.S.) / Q000592:standards*; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000628:therapy*; D010052:Ovariectomy; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
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