Adherence to Treatment Guidelines for Ovarian Cancer as a Measure of Quality Care

Bristow, Robert E. MD, MBA; Chang, Jenny MPH; Ziogas, Argyrios; Anton-Culver, Hoda PhD

doi: 10.1097/AOG.0b013e3182922a17
Original Research

OBJECTIVES: To validate National Comprehensive Cancer Network ovarian cancer guideline adherence as a quality process measure associated with improved survival, and to identify structural health care characteristics predictive of adherence to National Comprehensive Cancer Network guideline care.

METHODS: Consecutive patients with epithelial ovarian cancer diagnosed between 1 January 1999 and 31 December 2006 were identified from the California Cancer Registry. Adherence to National Comprehensive Cancer Network guideline care was defined by stage-appropriate surgical procedures and recommended chemotherapy. Multivariable logistic regression models were used to identify characteristics predictive of National Comprehensive Cancer Network guideline adherence and ovarian cancer–specific survival.

RESULTS: A total of 13,321 patients were identified. Overall, 37.2% of patients received National Comprehensive Cancer Network guideline–adherent care. Guideline-adherent care was associated with high-volume hospitals (20 or more cases per year; 50.8% compared with 34.1%; P<.001) and high-volume physicians (10 or more cases per year; 47.6% compared with 34.5%; P<.001). After controlling for other factors, both low-volume hospitals (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.66–2.01) and low-volume physicians (OR 1.19, 95% CI 1.07–1.32) were independently associated with deviation from National Comprehensive Cancer Network guidelines. On multivariable survival analysis, nonadherence to National Comprehensive Cancer Network guideline care was associated with decreased disease-specific survival (hazard ratio [HR] 1.33, 95% CI 1.26–1.41). Both low-volume hospitals (HR 1.08, 95% CI 1.01–1.16) and low-volume physicians (HR 1.18, 95% CI 1.09–1.28) were associated with decreased disease-specific survival after adjusting for National Comprehensive Cancer Network guideline–adherent care.

CONCLUSIONS: Adherence to National Comprehensive Cancer Network guidelines for treatment of ovarian cancer is correlated with improved survival and may be a useful process measure of quality cancer care. Ovarian cancer case volume correlates with a higher likelihood of recommended care and improved survival and may be a useful structural quality measure. Increased efforts to concentrate ovarian cancer care are warranted.

LEVEL OF EVIDENCE: II

Adherence to treatment guidelines for ovarian cancer is correlated with survival and may be a useful process measure of quality cancer care.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine-Medical Center, Orange, California; and the Department of Epidemiology, University of California, Irvine, Irvine, California.

Corresponding author: Robert E. Bristow, MD, MBA, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, 101 The City Drive, Building 56, Room 260, Orange, CA 92868; e-mail: rbristow@uci.edu.

Dr. Bristow was supported in part by the Queen of Hearts Foundation.

Presented at the Society of Gynecologic Oncology 44th Annual Meeting on Women's Cancer, March 9–12, 2013, Los Angeles, California.

© 2013 The American College of Obstetricians and Gynecologists