More Is Better: Breast Cancer Survival Higher in Hospitals Treating Many Patients
May 23, 2000 (New Orleans) -- As with heart surgery patients, the care of breast cancer patients appears to be better when carried out in hospitals that treat more of these patients. A new nationwide study reported Sunday at a meeting of the nation's leading cancer physicians and researchers shows that survival from breast cancer is significantly reduced at hospitals that treat fewer than 25 women with breast cancer a year, compared with hospitals that treat more patients.
A clear connection exists between hospitals that treat many patients and how well those patients do for many diseases, says Bruce Hillner, MD, who commented on the study for WebMD. "What we don't know is how many [patients] does a hospital have to treat to be good enough," he tells WebMD. Hillner is a professor of medicine at Virginia Commonwealth University Medical Center in Richmond.
The difference in survival for breast cancer patients "is significant enough that patients sent for treatment at low-volume hospitals may want to seek another opinion at a larger hospital if feasible," study researcher Monica Morrow, MD, noted in a prepared statement released by the American Society of Clinical Oncology (ASCO). This difference between hospitals that treat more than 25 women with breast cancer and those that treat fewer appears to be related to what Morrow calls "systems of care." These systems refer to patterns of care such as speed of referrals through a hospital system and coordination of care among various specialties. So the difference in survival outcomes is "not simply due to poor physician care," she tells WebMD. Morrow is professor of surgery at Northwestern University Medical School in Chicago.
Morrow and colleagues examined the medical records of more than 175,000 women with breast cancer who were treated nationwide at nearly 1,300 hospitals. The researchers found that survival at the low-volume hospitals -- hospitals that treated fewer than 25 patients -- was 18% less than was seen at larger volume hospitals. "If we had a treatment that provided a 20% difference, we would want to use it," Morrow said in the ASCO statement.
We need to examine the systems of care in large hospitals to see how their strategies can be applied to hospitals that treat fewer numbers of patients, Morrow says. To ensure the best possible care, she suggests women request that a team of appropriate experts -- including health care experts in surgery, chemotherapy, radiation, and quality of life issues -- coordinate their care.
Morrow and her colleagues conclude that hospitals treating more than 25 cases of breast cancer a year report better rates of patients surviving than those centers that treat fewer patients and that the difference persists regardless of which treatment combinations the patients receive. Also, the difference is not likely to be due to other diseases that the patients may have had at time of their cancer.