Women who undergo surgery for ovarian cancer at hospitals with high-volume experience better results than those who have surgery at low-volume hospitals, according to researchers from the Herbert Irving Comprehensive Cancer Center (HICC) at NewYork-Presbyterian/Columbia University Medical Center and published before print in the Journal of Clinical Oncology.

Survival rates improve because of complication treatments, and not because of post-surgical complications. Actually, those who experience complications post surgery at hospitals with low-volume have an almost 50 percent higher likelihood of dying due to the complications than patients who are treated at hospitals with high-volume.

Ovarian cancer occurs when growths appear on the ovaries. Symptoms of ovarian cancer are usually extremely subtle, however, they may include:

  • pelvic pain
  • bloating
  • frequent urination
  • difficulty eating

Around 90% of ovarian cancers are considered “epithelial” and have been found to rise above the ovary.

Jason D. Wright, the Levine Family Assistant Professor of Women’s Health and the Florence Irving Assistant Professor of Obstetrics and Gynecology at CUMC, a gynecologic oncologist at NYP/Columbia, and a member of the HICCC, said: “It is widely documented that surgical volume has an important effect on outcomes following surgery.”

Wright continued:

“We examined three specific areas: the influence of hospital volume on complications, failure to rescue from complications, and inpatient mortality in ovarian cancer patients who underwent cancer-related surgery. But the mortality rate did not coincide with the complication rate. For women who experienced a complication at a low-volume hospital, the mortality rate was 8 percent. For women at a high-volume hospital, it was 4.9 percent. After adjusting for variables, we concluded that the failure-to-rescue rate was 48 percent higher at low-volume hospitals than at high-volume hospitals. In short, high-volume hospitals are better about to rescue patients with complications following ovarian cancer surgery.”

To discover their findings, the researchers utilized National Inpatient Sample data from 1998 to 2009, in particular, over 36,000 women with ovarian cancer between the ages of 18 and 90 who had undergone an oophorectomy (removal of either one ovary or both) at 1,166 hospitals.

After analyzing the data, the experts identified a number of important patterns. One example of their findings, was that the incidence of complications increased with surgical volume: 20.4% for patients treated at hospitals with low-volume, as opposed to 24.6% at high-volume hospitals.

Even though the researchers could not explain all of the factors which may have impacted their findings, their conclusions suggest significant evidence for how patients with ovarian cancer are cared for.

Dawn L. Hershman, MD, associate professor of medicine and epidemiology at CUMC, an oncologist at NYP/Columbia, co-leader of the Breast Cancer Program at the HICCC, and a co-author of the trial, concluded:

“Our findings suggest that targeted initiatives to improve the care of patients with complications can improve outcomes. We also believe in the importance of adhering to quality guidelines and best practices, which may overcome these volume-based disparities.

And at the most basic level, the findings highlight the importance of preventing complications to begin with. They increase mortality in the worst-case scenario, but can also cause long-term medical problems, with patients and families facing difficult treatment choices and additional costs.”

Written by Christine Kearney