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Abstract：
We sought to evaluate whether provider volume or other factors are associated with chemotherapy guideline compliance in elderly patients with epithelial ovarian cancer (EOC).
We queried the SEER-Medicare database for patients ≥66 years, diagnosed with FIGO stage II-IV EOC from 2004 to 2013 who underwent surgery and received chemotherapy within 7 months of diagnosis. We compared NCCN guideline compliance (6 cycles of platinum-based doublet) and chemotherapy-related toxicities across provider volume tertiles. Factors associated with guideline compliance and chemotherapy-related toxicities were assessed using logistic regression. Overall survival (OS) was compared across volume tertiles and Cox proportional-hazards model was created to adjust for case-mix.
1924 patients met inclusion criteria. The overall rate of guideline compliance was 70.3% with a significant association between provider volume and compliance (64.5% for low-volume, 72.2% for medium-volume, 71.7% for high-volume, p = .02). In the multivariate model, treatment by low-volume providers and patient age ≥ 80 years were independently associated with worse chemotherapy-guideline compliance. In the survival analysis, there was a significant difference in median OS across provider volume tertiles with median survival of 32.8 months (95%CI 29.6, 36.4) low-volume, 41.9 months (95%CI 37.5, 46.7) medium-volume, 42.1 months (95%CI 38.8, 44.2) high-volume providers, respectively (p < .01). After adjusting for case-mix, low-volume providers were independently associated with higher rates of mortality (aHR 1.25, 95%CI: 1.08, 1.43).
In a modern cohort of elderly Medicare patients with advanced EOC, we found higher rates of non-compliant care and worse survival associated with treatment by low-volume Medicare providers. Urgent efforts are needed to address this volume-outcomes disparity.
We queried the SEER-Medicare database for patients ≥66 years, diagnosed with FIGO stage II-IV EOC from 2004 to 2013 who underwent surgery and received chemotherapy within 7 months of diagnosis. We compared NCCN guideline compliance (6 cycles of platinum-based doublet) and chemotherapy-related toxicities across provider volume tertiles. Factors associated with guideline compliance and chemotherapy-related toxicities were assessed using logistic regression. Overall survival (OS) was compared across volume tertiles and Cox proportional-hazards model was created to adjust for case-mix.
1924 patients met inclusion criteria. The overall rate of guideline compliance was 70.3% with a significant association between provider volume and compliance (64.5% for low-volume, 72.2% for medium-volume, 71.7% for high-volume, p = .02). In the multivariate model, treatment by low-volume providers and patient age ≥ 80 years were independently associated with worse chemotherapy-guideline compliance. In the survival analysis, there was a significant difference in median OS across provider volume tertiles with median survival of 32.8 months (95%CI 29.6, 36.4) low-volume, 41.9 months (95%CI 37.5, 46.7) medium-volume, 42.1 months (95%CI 38.8, 44.2) high-volume providers, respectively (p < .01). After adjusting for case-mix, low-volume providers were independently associated with higher rates of mortality (aHR 1.25, 95%CI: 1.08, 1.43).
In a modern cohort of elderly Medicare patients with advanced EOC, we found higher rates of non-compliant care and worse survival associated with treatment by low-volume Medicare providers. Urgent efforts are needed to address this volume-outcomes disparity.
摘要：
我们试图评估提供者数量或其他因素是否与老年上皮性卵巢癌（EOC）患者的化疗指南依从性相关。
我们查询了SEER-Medicare数据库中≥66岁的患者，2004年至2013年诊断为FIGOII-IV期EOC,在诊断后7个月内接受手术和化疗.我们比较了NCCN指南依从性（6个周期的铂类双联疗法）和化疗相关毒性，这些毒性在提供者的体积范围内。使用逻辑回归评估与指南依从性和化疗相关毒性相关的因素。比较了总生存率（OS），并创建了Cox比例风险模型以适应病例混合。
1924例患者符合纳入标准。指南依从性的总体率为70.3%，提供者数量和依从性之间存在显著关联(低数量为64.5%，中等体积的72.2%，大批量71.7%，p=.02）。在多变量模型中，低容量提供者的治疗和患者年龄≥80岁与化疗指南依从性较差独立相关.在生存分析中，提供方容量三元组的中位OS差异显着，中位生存期为32.8个月（95CI29.6,36.4），41.9个月（95CI37.5，46.7）中等体积，42.1个月（95CI38.8，44.2）大批量提供商，分别（p<0.01）。调整外壳混合后，低容量医疗服务提供者与较高的死亡率独立相关(aHR1.25,95CI:1.08,1.43).
在现代老年医疗保险患者中，我们发现,与低量Medicare提供者的治疗相关的非依从护理比率更高,生存率更差.需要紧急努力解决这种数量成果差距。
我们查询了SEER-Medicare数据库中≥66岁的患者，2004年至2013年诊断为FIGOII-IV期EOC,在诊断后7个月内接受手术和化疗.我们比较了NCCN指南依从性（6个周期的铂类双联疗法）和化疗相关毒性，这些毒性在提供者的体积范围内。使用逻辑回归评估与指南依从性和化疗相关毒性相关的因素。比较了总生存率（OS），并创建了Cox比例风险模型以适应病例混合。
1924例患者符合纳入标准。指南依从性的总体率为70.3%，提供者数量和依从性之间存在显著关联(低数量为64.5%，中等体积的72.2%，大批量71.7%，p=.02）。在多变量模型中，低容量提供者的治疗和患者年龄≥80岁与化疗指南依从性较差独立相关.在生存分析中，提供方容量三元组的中位OS差异显着，中位生存期为32.8个月（95CI29.6,36.4），41.9个月（95CI37.5，46.7）中等体积，42.1个月（95CI38.8，44.2）大批量提供商，分别（p<0.01）。调整外壳混合后，低容量医疗服务提供者与较高的死亡率独立相关(aHR1.25,95CI:1.08,1.43).
在现代老年医疗保险患者中，我们发现,与低量Medicare提供者的治疗相关的非依从护理比率更高,生存率更差.需要紧急努力解决这种数量成果差距。
