Trends in Hospital Volume and Patterns of Referral for Women With Gynecologic Cancers

Wright, Jason D. MD; Neugut, Alfred I. MD, PhD; Lewin, Sharyn N. MD; Lu, Yu-Shiang MS; Herzog, Thomas J. MD; Hershman, Dawn L. MD

doi: 10.1097/AOG.0b013e31828ec686
Original Research

OBJECTIVE: To estimate trends in hospital volume and referral patterns for women with uterine and ovarian cancer.

METHODS: The Surveillance, Epidemiology, and End Results–Medicare database was used to identify women aged 65 years or older with ovarian and uterine cancer who underwent surgery from 2000 to 2007. “Volume creep,” when a greater number of patients undergo surgery at the same hospitals, and “market concentration,” when a similar overall number of patients undergo a procedure but at a smaller number of hospitals, were analyzed.

RESULTS: Among 4,522 patients with ovarian cancer, mean hospital volume increased from 3.1 cases during 2000–2001 to 3.4 cases during 2006–2007 (P=.62) suggesting minimal volume creep. Similarly, there was little evidence of market concentration. In 2000–2001, 37.8% of women were treated at the top decile by volume hospitals compared with 41.4% in 2006–2007 (P=.14). In 2006–2007, 201 (63.2%) of the hospitals had an ovarian cancer surgery volume of two or fewer cases. Among 9,908 women with uterine cancer, the mean hospital volume increased slightly from 4.5 in 2000–2001 to 5.4 in 2006–2007 (P=.10). The percentage of patients treated at the top decile by volume of hospitals increased from 40.4% in 2000–2001 to 44.7% in 2006–2007 (P<.001). In 2006–2007, 243 (49.3%) of the hospitals had a uterine cancer surgery volume of two or fewer cases.

CONCLUSION: There have been only modest changes in the referral patterns of women with ovarian and uterine cancer. A large number of hospitals have a very low procedural volume.

LEVEL OF EVIDENCE: II

There have been only modest changes in the referral patterns for women with ovarian and uterine cancer.

Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.

Corresponding author: Jason D. Wright, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 8th Floor, New York, NY 10032; e-mail: jw2459@columbia.edu.

Dr. Hershman is the recipient of a grant from the National Cancer Institute (NCI R01CA134964). This study used the linked Surveillance, Epidemiology, and End Results–Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors appreciate the efforts of the Applied Research Branch, Division of Cancer Prevention and Population Science, National Cancer Institute; the Office of Information Services, and the Office of Strategic Planning, Health Care Financing Administration; Information Management Services, Inc; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER–Medicare database.

© 2013 The American College of Obstetricians and Gynecologists