scholarly journals Variation in receipt of therapy and survival with provider volume for medical oncology in non-curative esophago-gastric cancer: a population-based analysis

2019 ◽  
Vol 23 (2) ◽  
pp. 300-309 ◽  
Author(s):  
Julie Hallet ◽  
Laura E. Davis ◽  
Alyson L. Mahar ◽  
Ying Liu ◽  
Victoria Zuk ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Medical Oncology ◽  
Population Based ◽  
Provider Volume

590 VARIATION IN RECEIPT OF THERAPY AND SURVIVAL WITH PROVIDER-VOLUME IN NON-CURATIVE ESOPHAGO-GASTRIC CANCER: A POPULATION-BASED ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Julie Hallet ◽  
Laura Davis ◽  
Alyson Mahar ◽  
Ying Lui ◽  
Victoria Zuk ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systemic Therapy ◽  
Medical Oncology ◽  
High Volume ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Income Quintile ◽  
Care Organization ◽  
Comorbidity Burden ◽  
Provider Volume

Abstract   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. Methods 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) providers 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 provider, receipt of systemic therapy, and OS. Results 7,011 EGC patients with non-curative management consulted with medical oncology. One-year OS was superior for HV providers (>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 provider 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). Conclusion Medical oncology provider-volume was associated with variation in non-curative management and outcomes of EGC. Care by a HV provider 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; increase in the number of HV providers may reduce variation and improve outcomes.

Provider-volume associated with variable receipt of therapy and outcomes for noncurative pancreas adenocarcinoma: A population-based analysis.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 352-352 ◽  
Author(s):  
Julie I. Hallet ◽  
Laura Davis ◽  
Michail Mavros ◽  
Alyson L. Mahar ◽  
Kaitlyn Beyfuss ◽  
...  
Keyword(s):  
Median Survival ◽  
Systemic Therapy ◽  
Medical Oncology ◽  
High Volume ◽  
Population Based ◽  
Income Quintile ◽  
Care Organization ◽  
Comorbidity Burden ◽  
Provider Volume ◽  
Oncology Providers

352 Background: While high-volume providers for pancreatic adenocarcinoma (PA) surgery yield better outcomes, variation in practice and the role of provider-volume has not been investigated for systemic therapy. We examined variation in practice and outcomes in the management of non-curative PA, based on medical oncology provider-volume. Methods: We conducted a population based retrospective cohort study of non-resected PA over 2005-2016 by linking administrative healthcare datasets. High-volume (HV) medical-oncology providers were defined as the 5th quintile of number of PA seen per provider per year. Outcomes were receipt of chemotherapy and overall survival (OS). Brown Forsythe Levene (BFL) test for equality of variances assessed outcomes variability between provider-volume quintiles (Q1 to 5). Multivariate regressions examined the association between management by HV provider and receipt of systemic therapy and OS. Results: Of 10,881 non-curative PA patients, 7,062 consulted with medical oncology. Among 341 medical oncology providers, 3% were HV, defined as > 16 patients/year. There was variability in receipt of chemotherapy based on provider-volume, with 44% (IQR: 25-54) for Q1 and 47% (IQR: 43-54) for Q5, and in median survival, with 4.1 months (IQR: 2.7-6.2) for Q1 and 7.5 months (IQR: 6.6-8.0) for Q5. Variability between provider-volume quintiles was significant for receipt of chemotherapy and median survival (both BFL p < 0.001). After adjusting for age, sex, comorbidity burden, rurality, income quintile, and diagnosis year, HV provider was independently associated with higher odds of receiving chemotherapy (OR 1.19 [1.05-1.34]), and superior OS (HR 0.79 [0.74-0.84]). Conclusions: There was significant variation in non-curative management and outcomes of PA based on provider-volume. Management by a HV provider 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. Cancer care systems could consider initiatives to increase the number of HV providers to reduce variation and improve outcomes.

scholarly journals Benefits of High-Volume Medical Oncology Care for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis

2020 ◽  
Vol 18 (3) ◽  
pp. 297-303 ◽  
Author(s):  
Julie Hallet ◽  
Laura Davis ◽  
Alyson Mahar ◽  
Michail Mavros ◽  
Kaitlyn Beyfuss ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Medical Oncology ◽  
High Volume ◽  
Population Based ◽  
Care Organization ◽  
Comorbidity Burden ◽  
Provider Volume ◽  
Care Systems ◽  
Oncology Care ◽  
Oncology Providers

Background: Although pancreatic adenocarcinoma (PA) surgery performed by high-volume (HV) providers yields better outcomes, volume–outcome relationships are unknown for medical oncologists. This study examined variation in practice and outcomes in noncurative management of PA based on medical oncology provider volume. Methods: This population-based cohort study linked administrative healthcare datasets and included nonresected PA from 2005 through 2016. The volume of PA consultations per medical oncology provider per year was divided into quintiles, with HV providers (≥16 patients/year) constituting the fifth quintile and low-volume (LV) providers the first to fourth quintiles. Outcomes were receipt of chemotherapy and overall survival (OS). The Brown-Forsythe-Levene (BFL) test for equality of variances was performed to assess outcome variability between provider-volume quintiles. Multivariate regression models were used to examine the association between management by HV provider and outcomes. Results: A total of 7,062 patients with noncurable PA consulted with medical oncology providers. Variability was seen in receipt of chemotherapy and median survival based on provider volume (BFL, P<.001 for both), with superior 1-year OS for HV providers (30.1%; 95% CI, 27.7%–32.4%) compared with LV providers (19.7%; 95% CI, 18.5%–20.6%) (P<.001). After adjustment for age at diagnosis, sex, comorbidity burden, rural residence, income, and diagnosis period, HV provider care was independently associated with higher odds of receiving chemotherapy (odds ratio, 1.19; 95% CI, 1.05–1.34) and with superior OS (hazard ratio, 0.79; 95% CI, 0.74–0.84). Conclusions: Significant variation was seen in noncurative management and outcomes of PA based on provider volume, with management by an HV provider being independently associated with superior OS and higher odds of receiving chemotherapy. This information is important to inform disease care pathways and care organization. Cancer care systems could consider increasing the number of HV providers to reduce variation and improve outcomes.

scholarly journals Body composition and risk of gastric cancer: A population‐based prospective cohort study

2021 ◽  
Vol 10 (6) ◽  
pp. 2164-2174
Author(s):  
An‐Ran Liu ◽  
Qiang‐Sheng He ◽  
Wen‐Hui Wu ◽  
Jian‐Liang Du ◽  
Zi‐Chong Kuo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Body Composition ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Population Based

A population-based study of gastric cancer and Barrett's Esophagus in a rural population in Colombia: Lack of protection by H. Pylori

2000 ◽  
Vol 118 (4) ◽  
pp. A1382
Author(s):  
Hector Cardona ◽  
Oscar Gutierrez ◽  
J. Becerra ◽  
William Otero ◽  
Antonia Sepulveda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Barrett’S Esophagus ◽  
Rural Population ◽  
Barrett's Esophagus ◽  
Population Based ◽  
Population Based Study ◽  
H Pylori
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