Investigating the correlation between hospital of primary treatment and the survival of women with breast cancer

Authors

  • Nicole Hébert-Croteau M.D., M.P.H., Ph.D.,

    Corresponding author
    1. Direction des Systèmes de Soins et Services, Institut National de Santé Publique du Québec, Montréal, Québec, Canada
    2. Centre Intégré de Lutte Contre le Cancer de Montérégie, Hôpital Charles LeMoyne, Greenfield Park, Québec, Canada
    • Institut National de Santé Publique du Québec, 4835, Avenue Christophe-Colomb, Montréal, Québec H2J 3G8, Canada
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    • Fax: (514) 597-1616

  • Jacques Brisson M.D., Sc.D.,

    1. Direction des Systèmes de Soins et Services, Institut National de Santé Publique du Québec, Montréal, Québec, Canada
    2. Unité de Recherche en Santé des Populations, Centre Hospitalier Affilié Universitaire de Québec, Québec, Québec, Canada
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  • Jacques Lemaire Ph.D.,

    1. Département des Sciences Infirmières, Faculté de Médecine, Université de Sherbrooke, Longueuil, Québec, Canada
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  • Jean Latreille M.D.C.M.,

    1. Centre Intégré de Lutte Contre le Cancer de Montérégie, Hôpital Charles LeMoyne, Greenfield Park, Québec, Canada
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  • Raynald Pineault M.D., Ph.D.

    1. Direction de Santé Publique de Montréal-Centre, Montréal, Québec, Canada
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  • Presented in part at the fourth European Breast Cancer Conference, Hamburg, Germany, March 16–20, 2004.

Abstract

BACKGROUND

To understand the relation between hospital of initial treatment and the survival of women with breast cancer, the authors investigated the characteristics of the treatment center that were related most to outcome.

METHODS

The authors selected women from 5 regions of Quebec, Canada, who were diagnosed with lymph node-negative breast cancer between 1988 and 1994. Data were collected by chart review, queries to physicians, and linkage with administrative data bases. Overall survival to the end of 1999 was analyzed using the Kaplan–Meier method and Cox proportional hazards models.

RESULTS

The study population included 1727 women with a median follow-up of 6.8 years. The 7-year survival rate was 82% (95% confidence interval [95%CI], 80–84%). Compared with women who were treated in centers with ≥ 100 new cases per year, the hazard ratio (HR) of death from any cause was 1.80 (95%CI, 1.23–2.63), 1.44 (95%CI, 1.03–2.03), and 1.30 (95%CI, 0.96–1.76) among women who were treated in hospitals with < 25 new cases, 25–49 new cases, and 50–99 new cases per year after adjusting for case mix and characteristics of the attending physician. However, the significance of caseload disappeared after adjusting for the type of hospital. By contrast, women who were treated in centers with either on-site radiotherapy, research activity, or teaching status had significantly better outcomes, even after adjusting for caseload (HR, 0.68; 95%CI, 0.50–0.92). These associations were independent of primary treatment received, which was a strong determinant of outcome.

CONCLUSIONS

Primary treatment of early-stage breast cancer in larger hospitals was associated with improved survival. This relation was mediated by factors related to proficiency of care, which tended to cluster within institutions. Cancer 2005. © 2005 American Cancer Society.

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