Influence of department volume on cancer survival for gynaecological cancers--a population-based study in Tyrol, Austria.

OBJECTIVE

The objective of this study was to assess the effect of department volume on survival of patients with gynaecological cancer.

METHODS

We conducted an observational population-based study in Tyrol, Austria. The analysis includes all patient data on incident gynaecological cancer collected by the Cancer Registry of Tyrol. Data were collected since 1988 on a population-based perspective; publication of incidence data since 1988 in Cancer Incidence in Five Continents gives evidence for good completeness and validity of the database. Patient survival status is assessed in a passive way by probabilistic record linkage between incidence data and official mortality data. We applied a multivariate Cox regression with variables age, sex, stage, year of diagnosis, histological verification of diagnosis, transfer to other hospital and department volume. Department volume was categorised in < or = 11/12-23/24-35/ > or = 36 patients per year reflecting one/two/three/more than three patients per month; categories were computed separately for every site we analysed. Departments with up to 11 patients per year were called small departments.

RESULTS

For 4,191 breast cancer patients, we found a negative effect for small departments; hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.22, 1.58. For ovarian cancer patients, we also found a negative effect for small departments (HR 1.27, 95% CI 1.05, 1.54). For cervical cancer patients, we found a positive effect for small departments (HR 0.67, 95% CI 0.51, 0.88). No effect was shown for corpus cancer (HR 0.80, 95% CI 0.63, 1.01).

CONCLUSION

The results indicate that, in our country, rules on minimum department case-load can further improve survival for breast and ovarian cancer patients.