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Breast cancer care faulted in community hospitals

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Reuters Health

Thursday, September 4, 2008

NEW YORK (Reuters Health) - Women who have advanced breast cancer treated in a local community hospital appear to have a lower long-term survival rate than their counterparts treated at academic medical centers, a new study indicates.

The researchers say the reason, at least in part, seems to be that community hospitals are not making full use of proven, life-extending treatments.

A number of studies have found that the survival rates after fairly high-risk surgeries are better in so-called teaching hospitals. These centers are usually affiliated with a nearby medical school and, compared with community hospitals, often see a higher volume of patients and have more manpower and resources.

The current study looked at whether teaching hospitals also have better outcomes when it comes to long-term breast cancer survival, which depends not only on a woman's initial surgery but her overall care.

Researchers 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 5 to 10 years later.

Among women treated at one of eight academic centers, 84 percent and 72 percent were alive 5 and 10 years later, respectively. Those figures were 81 percent and 69 percent at busy "high volume" community hospitals, and 77 percent and 63 percent at smaller community hospitals, the researchers report in the Annals of Surgery.

The difference was mainly seen among women with more advanced breast cancer.

For example, for women with breast cancer that had spread to distant sites in the body, the 5-year survival rate of those treated in a teaching hospital was 47 percent, versus 25 percent among those treated at a community hospital.

The discrepancy seemed to be attributable to lower rates of "adjuvant" therapy at community hospitals, explained senior researcher Dr. Leonidas G. Koniaris, of the University of Miami School of Medicine.

Adjuvant therapy refers to the chemotherapy, radiation and hormonal treatments that can be given in addition to surgery. In this study, adjuvant therapies were linked to a lower risk of death, and community hospitals had lower rates of such therapies even among women with advanced cancer.

"For early breast cancer, we don't see a major difference" between survival rates at teaching and community hospitals, Koniaris told Reuters Health. But when it comes to more advanced stages of breast cancer, he said, individual therapies like chemotherapy or hormonal drugs make a greater difference in a woman's long-term survival.

The findings are based on cancer surveillance data kept by the state of Florida. It's not possible to tell from the data why community hospitals had lower rates of adjuvant therapy, Koniaris said.

In some cases, patients might have refused additional treatment, he noted, while in others, the doctor might not have "pushed" for it. In some instances, adjuvant treatment might not have been offered at all.

The bottom line for patients, Koniaris said, is that they should ask their doctors about all of the treatment options that are appropriate for them, so that they can make a "fully informed choice" about which ones to pursue.

For the health system's part, whether it's a community or teaching hospital, Koniaris said, it's important for all of the providers caring for a women -- such as surgeons, oncologists and radiologists -- to communicate with each other and make sure the patient is getting the best treatment.

"They need to make sure patients don't fall through the cracks," he said.

SOURCE: Annals of Surgery, August 2008.

Reuters Health

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