ASO Author Reflections: Hospital Volume, Cancer Outcomes and Access to Specialized Care
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Hospital Volume, Cancer Outcomes and Access to Specialized Care Camille C. Baumrucker, BS1, and Francis I. Macedo, MD2 1
Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL ; 2Division of Surgical Oncology, Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL
PAST Increasing efforts have been made to describe the hospital volume-outcome relationship in order to improve the care of cancer patients. As a result, centralization of specialized care has been proposed to improve postoperative outcomes. However, there is concern regarding socioeconomic and geographical inequalities in access to care. For underserved populations and for those living in rural areas, centralization increases travel distance and financial burdens. Centralization of care alone may not be a simple solution as it sparks a debate on the trade-off between highquality service and equal access to care. PRESENT Multiple studies have demonstrated a reduction in overall mortality among breast cancer (BC) patients treated at high-volume centers.1 This relationship has not yet been shown in certain BC subgroups, including occult breast cancer (OBC). Our study examined the impact of hospital volume on surgical decision making and survival outcomes in this population.2 Patients treated at academic centers had a 21-month survival advantage over patients treated at community centers (108 months vs 87 months; p = 0.026). Additionally, academic centers had a 25% reduction in the rate of modified radical mastectomy (MRM). However,
Ó Society of Surgical Oncology 2020 First Received: 3 September 2020 Accepted: 8 September 2020 C. C. Baumrucker, BS e-mail: [email protected]
there were no statistically significant survival differences between high- and low-volume hospitals when analyzing breast-conserving therapy and MRM separately. This suggests that the direct association between hospital volume and BC survival may not be explained solely by surgical outcomes. FUTURE The solution to narrowing this volume-outcome gap may be twofold: centralization with increased access to specialized care and improvement of the quality of care at low-volume hospitals. Centralization of care is key to providing high quality specialized cancer care; although it is limited by spatial and financial disparities. The increased use of telemedicine initiatives may have recently diminished some of these disparities by increasing access to cancer care and decreasing travel costs, especially in rural areas.3 Future efforts should expand the use of telemedicine to increase staff training and clinician education at low-volume hospitals. Improving the care at low-volume hospitals depends on the use of quality care processes. Multidisciplinary care meetings have been shown to improve efficiency of referrals, continuity of care, and clinical outcomes
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