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Association of Hospital Procedure Volume and Outcomes in Patients with Colon Cancer at High Risk for Recurrence

Jeffrey A. Meyerhardt, MD; Paul J. Catalano, ScD; Deborah Schrag, MD, MPH; John Z. Ayanian, MD, MPP; Daniel G. Haller, MD; Robert J. Mayer, MD; John S. Macdonald, MD; Al B. Benson III, MD; and Charles S. Fuchs, MD, MPH
[+] Article and Author Information

From Dana-Farber Cancer Institute, Eastern Cooperative Oncology Group Statistical Center, and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Memorial Sloan-Kettering Cancer Center and St. Vincent Clinical Cancer Center, New York, New York; University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania; and Northwestern University, Chicago, Illinois.


Acknowledgments: The authors thank Shandi Smith and Trong Ao for their assistance in data collection and Mike Hadad for his help in compiling Medicare volume data.

Grant Support: Dr. Meyerhardt is supported in part by a K07 award from the National Cancer Institute (1K07CA097992-01A1) and an American Society of Clinical Oncology career development award.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jeffrey A. Meyerhardt, MD, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.

Current Author Addresses: Drs. Meyerhardt, Catalano, Mayer, and Fuchs: Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.

Dr. Schrag: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 221, New York, NY 10021.

Dr. Ayanian: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Haller: University of Pennsylvania Cancer Center, 3400 Spruce Street, 16 Penn Tower, Philadelphia, PA 19104-4204.

Dr. Macdonald: St. Vincent's Comprehensive Cancer Center, 325 West 15th Street, New York, NY 10011.

Dr. Benson: Northwestern University, 676 North St. Clair Street, Suite 850, Chicago, IL 60611.

Author Contributions: Conception and design: J.A. Meyerhardt, P.J. Catalano, J.Z. Ayanian, D.G. Haller, R.J. Mayer, J.S. Macdonald, C.S. Fuchs.

Analysis and interpretation of the data: J.A. Meyerhardt, P.J. Catalano, D. Schrag, J.Z. Ayanian, C.S. Fuchs.

Drafting of the article: J.A. Meyerhardt, D. Schrag, C.S. Fuchs.

Critical revision of the article for important intellectual content: J.A. Meyerhardt, D. Schrag, J.Z. Ayanian, D.G. Haller, R.J. Mayer, A.B. Benson III.

Final approval of the article: J.A. Meyerhardt, P.J. Catalano, D. Schrag, J.Z. Ayanian, D.G. Haller, R.J. Mayer, J.S. Macdonald, A.B. Benson III, C.S. Fuchs.

Provision of study materials or patients: J.A. Meyerhardt, D.G. Haller, R.J. Mayer, J.S. Macdonald, A.B. Benson III.

Statistical expertise: J.A. Meyerhardt, P.J. Catalano, C.S. Fuchs.

Obtaining of funding: J.A. Meyerhardt, C.S. Fuchs.

Administrative, technical, or logistic support: P.J. Catalano.

Collection and assembly of the data: J.A. Meyerhardt.


Ann Intern Med. 2003;139(8):649-657. doi:10.7326/0003-4819-139-8-200310210-00008
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In this large trial of adjuvant chemotherapy in patients with high-risk stage II and stage III colon cancer, overall survival after curative surgery was significantly improved among patients who underwent surgery at a hospital with a high volume of colon cancer surgeries. Nonetheless, despite the 16% increase in overall mortality observed among patients resected at low-volume centers, we saw no significant relation between hospital procedure volume and the risk for cancer recurrence or cancer-specific mortality.

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Figure 1.
Overall survival for patients with colon cancer by hospital procedure volume.

*Values are number of events/number of patients at risk.

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Grahic Jump Location
Figure 2.
Recurrence-free survival for patients with colon cancer by hospital procedure volume.

*Values are number of events/number of patients at risk.

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Summary for Patients

Relationships between the Amount of Colon Cancer Surgery a Hospital Performs and Patient Outcomes

The summary below is from the full report titled “Association of Hospital Procedure Volume and Outcomes in Patients with Colon Cancer at High Risk for Recurrence.” It is in the 21 October 2003 issue of Annals of Internal Medicine (volume 139, pages 649-657). The authors are J.A. Meyerhardt, P.J. Catalano, D. Schrag, J.Z. Ayanian, D.G. Haller, R.J. Mayer, J.S. Macdonald, A.B. Benson III, and C.S. Fuchs.

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