Variation in receipt of therapy and survival with provider volume for medical oncology in non-curative esophago-gastric cancer: a population-based analysis
- 81 Downloads
While surgical care by high-volume providers for esophago-gastric cancer (EGC) yields better outcomes, volume–outcome relationships are unknown for systemic therapy. We examined receipt of therapy and outcomes in the non-curative management of EGC based on medical oncology provider volume.
We conducted a population based retrospective cohort study of non-curative EGC over 2005–2017 by linking administrative healthcare datasets. The volume of new EGC consultations per medical oncology provider per year was calculated and divided into quintiles. High-volume (HV) medical oncologists were defined as the 4–5th quintiles. Outcomes were receipt of chemotherapy and overall survival (OS). Multivariate logistic and Cox-proportional hazards regressions examined the association between management by HV medical oncologist, receipt of systemic therapy, and OS.
7011 EGC patients with non-curative management consulted with medical oncology. 1-year OS was superior for HV medical oncologists (> 11 patients/year), with 28.4% (95% CI 26.7–30.2%) compared to 25.1% (95% CI 23.8–26.3%) for low volume (p < 0.001). After adjusting for age, sex, comorbidity burden, rurality, income quintile, and diagnosis year, HV medical oncologist was independently associated with higher odds of receiving chemotherapy (OR 1.13, 95% CI 1.01–1.26), and independently associated with superior OS (HR 0.89, 95% CI 0.84–0.93).
Medical oncology provider volume was associated with variation in non-curative management and outcomes of EGC. Care by an HV medical oncologist was independently associated with higher odds of receiving chemotherapy and superior OS, after adjusting for case mix. This information is important to inform disease care pathways and care organization; an increase in the number of HV medical oncologists may reduce variation and improve outcomes.
KeywordsEsophagus Stomach Cancer Outcomes Volume
This study was supported by the Canadian Institute of Health Research (FRN #154131) and the Sherif and Mary-Lou Hanna Chair in Surgical Oncology Research. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred.
This study was supported by the Canadian Institute of Health Research (FRN #154131).
Compliance with ethical standards
Conflict of interest
Julie Hallet has received speaking honoraria from Ipsen Biopharmaceuticals Canada and Novartis Oncology. Natalie Coburn receives salary support from Cancer Care Ontario as the Clinical Lead of Patient Reported Outcomes and Symptom Management. Laura Davis declares that she has not conflict of interest. Alyson Mahar declares that she has not conflict of interest. Ying Liu declares that she has not conflict of interest. Vaihbav Gupta declares that he has not conflict of interest. Craig Earle declares that he has not conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was waived by the Sunnybrook Health Sciences Centre Research Ethics Board, for the conduct of population-based analysis.
- 9.Huntington SF, Hoag JR, Zhu W, Wang R, Zeidan AM, Giri S, et al. Oncologist volume and outcomes in older adults diagnosed with diffuse large B cell lymphoma. Cancer. 2018;64:786–4220.Google Scholar
- 13.Institute of Medicine (US), and National Research Council (US) National Cancer Policy Board, Hewitt M, Petitti D. Interpreting the volume–outcome relationship in the context of cancer care. Washington (DC): National Academies Press; 2001.Google Scholar
- 14.Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Akinyemiju TF, Lami Al FH, Alam T, Alizadeh-Navaei R, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 2018;4:1553–688.CrossRefGoogle Scholar
- 18.Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol. 2006;24:4991–7.PubMedCrossRefPubMedCentralGoogle Scholar
- 20.Bang Y-J, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010;376:687–97.CrossRefGoogle Scholar
- 21.Canada GO, Canada H, Branch SP, Division CHA. Canada Health Act—Health Care System—Health Canada. https://www.hc-sc.gc.ca/hcs-sss/medi-assur/cha-lcs/index-eng.php.
- 24.Iron K, Zagorski BM, Sykora K, Manuel DG. Living and dying in Ontario: an opportunity for improved health information. ICES Investigative Report. Toronto: Institute for Clinical Evaluative Sciences; 2008.Google Scholar
- 26.Nam RK, Cheung P, Herschorn S, Saskin R, Su J, Klotz LH, et al. Incidence of complications other than urinary incontinence or erectile dysfunction after radical prostatectomy or radiotherapy for prostate cancer: a population-based cohort study. Lancet Oncol. 2014;15:223–31.PubMedCrossRefGoogle Scholar
- 29.Karlj B. Measuring, “rurality” for purposes of health-care planning: an empirical measure for Ontario. Ont Med Rev. 2009;67:33–52.Google Scholar
- 34.Kaplan EL, Meier P. Nonparametric Estimation from Incomplete Observations. J Am Stat Assoc. 2012;6:128–32.Google Scholar
- 40.Okines AFC, Norman AR, McCloud P, Kang Y-K, Cunningham D. Meta-analysis of the REAL-2 and ML17032 trials: evaluating capecitabine-based combination chemotherapy and infused 5-fluorouracil-based combination chemotherapy for the treatment of advanced oesophago-gastric cancer. Ann Oncol. 2009;20:1529–34.PubMedCrossRefGoogle Scholar