WASHINGTON—Sufficient evidence exists to suggest that patients undergoing pancreatic and esophageal cancer surgery have lower mortality rates at high-volume hospitals and that physicians and patients should consider this fact in making treatment decisions, a report by the Institute of Medicine (IOM) said.
The report, Interpreting the Volume-Outcome Relationship in the Context of Cancer Care, relies in part on a paper presented at an IOM workshop. In it, Ethan A. Halm, MD, Clara Lee, MD, and Mark R. Chassin, MD, of the Mount Sinai School of Medicine Department of Health Policy, New York, reviewed 20 population-based studies of surgical interventions for cancer. Three of the studies looked at more than one form of cancer.
Although the studies differed in design, methodology, and definition of high-volume and low-volume hospitals, "there is a consistency in the published results," the IOM report said. "A higher-volume-better-outcome association was observed in all but three of the studies reviewed (these three studies showed no volume-outcome association)."
Two years ago, in a report titled Ensuring Quality Cancer Care, the IOM’s National Cancer Policy Board recommended that "patients undergoing procedures that are technically difficult to perform and have been associated with higher mortality in lower volume settings receive care at facilities with extensive experience."
The new report further confirms and documents the tie between volume and outcome in difficult surgical procedures. However, "available evidence is insufficient to say that cancer care is better or worse when offered by specialized compared to generalist facilities or providers, or in managed care versus fee-for-service environments," the report said.
After assessing the paper by Dr. Halm and his colleagues, other materials, and the advice of workshop participants, the National Cancer Policy Board made two recommendations.
First, it urged that "when a large and significant volume-outcome relationship is established firmly by the literature through consistent findings in multiple studies (ie, esophagectomy, pancreatectomy), volume should be incorporated as a quality indicator into ongoing quality-of-care programs and initiatives."
