Breast Cancer Survival Rates Lower In Community Hospitals Than Teaching Hospitals, Study Finds

Main Category: Breast Cancer
Also Included In: Public Health
Article Date: 09 Sep 2008 - 9:00 PDT

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Women with advanced breast cancer have lower long-term survival rates when treated in local community hospitals than at academic medical centers, according to a study published in the Annals of Surgery, Reuters reports. The study found that among nearly 25,000 women treated at Florida hospitals between 1994 and 2000, those who received care at a teaching hospital were more likely to be alive five to 10 years later.

Among women treated at one of eight academic centers, researchers found that 84% and 72% were alive five and 10 years later, respectively. However, those figure decreased to 81% and 69% at busy "high volume" community hospitals and to 77% and 63% at smaller community hospitals.

In the study, the difference in long-term survival rates mainly was seen among women with more advanced breast cancer, Reuters reports. For example, among women with breast cancer that had spread to distant sites in the body, the five-year survival rate was 47% for those treated in a teaching hospital, compared with 25% of those receiving care at a community hospital.

Senior researcher Leonidas Koniaris of the University of Miami School of Medicine said such discrepancies are the result of lower rates of adjuvant therapy -- chemotherapy, radiation and hormonal treatments that can be given in addition to surgery -- in community hospitals. The study found that adjuvant therapies were linked to a lower risk of death and that community hospitals had lower rates of such therapies, even among women with advanced breast cancer. "For early breast cancer, we don't see a major difference" between survival rates at teaching and community hospitals, Koniaris said. However, Koniaris added that adjuvant therapies make a greater difference in long-term survival among women with advanced cancer.

According to Koniaris, the findings, which are based on Florida's cancer surveillance data, do not indicate why community hospitals had lower rates of adjuvant therapy. While in some cases patients might have refused additional treatment, Koniaris said it is possible that physicians might not have "pushed" for it. Adjuvant treatment might not have been offered in other instances, Koniaris added. He said the results of the study should influence patients to ask their physicians about all treatment options that are appropriate for them so that they can make a "fully informed choice" about which ones to pursue. In terms of the health system, Koniaris said that regardless of the type of institution, it is important for health care providers to communicate with each other and ensure the patient is receiving the best treatment. "They need to make sure patients don't fall through the cracks," he added (Norton, Reuters, 9/4).

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