Division of Hematology & Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2021 Jul 1;4(7):e2115675. doi: 10.1001/jamanetworkopen.2021.15675.
Increasing demand for cancer care may be outpacing the capacity of hospitals to provide timely treatment, particularly at referral centers such as National Cancer Institute (NCI)-designated and academic centers. Whether the rate of patient volume growth has strained hospital capacity to provide timely treatment is unknown.
To evaluate trends in patient volume by hospital type and the association between a hospital's annual patient volume growth and time to treatment initiation (TTI) for patients with cancer.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, hospital-level, cross-sectional study used longitudinal data from the National Cancer Database from January 1, 2007, to December 31, 2016. Adult patients older than 40 years who had received a diagnosis of 1 of the 10 most common incident cancers and initiated their treatment at a Commission on Cancer-accredited hospital were included. Data were analyzed between December 19, 2019, and March 27, 2020.
The mean annual rate of patient volume growth at a hospital.
The main outcome was TTI, defined as the number of days between diagnosis and the first cancer treatment. The association between a hospital's mean annual rate of patient volume growth and TTI was assessed using a linear mixed-effects model containing a patient volume × time interaction. The mean annual change in TTI over the study period by hospital type was estimated by including a hospital type × time interaction term.
The study sample included 4 218 577 patients (mean [SD] age, 65.0 [11.4] years; 56.6% women) treated at 1351 hospitals. From 2007 to 2016, patient volume increased 40% at NCI centers, 25% at academic centers, and 8% at community hospitals. In 2007, the mean TTI was longer at NCI and academic centers than at community hospitals (NCI: 50 days [95% CI, 48-52 days]; academic: 43 days [95% CI, 42-44 days]; community: 37 days [95% CI, 36-37 days]); however, the mean annual increase in TTI was greater at community hospitals (0.56 days; 95% CI, 0.49-0.62 days) than at NCI centers (-0.73 days; 95% CI, -0.95 to -0.51 days) and academic centers (0.14 days; 95% CI, 0.03-0.26 days). An annual volume growth rate of 100 patients, a level observed at less than 1% of hospitals, was associated with a mean increase in TTI of 0.24 days (95% CI, 0.18-0.29 days).
In this cross-sectional study, from 2007 to 2016, across the studied cancer types, patients increasingly initiated their cancer treatment at NCI and academic centers. Although increases in patient volume at these centers outpaced that at community hospitals, faster growth was not associated with clinically meaningful treatment delays.
癌症治疗的需求不断增加，可能超过医院及时提供治疗的能力，尤其是在癌症研究所 (NCI) 指定和学术中心等转诊中心。目前尚不清楚患者数量的增长速度是否对医院及时提供治疗的能力造成了压力。
评估不同医院类型的患者数量趋势，以及医院年度患者数量增长率与癌症患者治疗开始时间 (TTI) 之间的关系。
设计、地点和参与者：这是一项回顾性、医院水平、横断面研究，使用了 2007 年 1 月 1 日至 2016 年 12 月 31 日期间国家癌症数据库的纵向数据。纳入在癌症委员会认证的医院接受治疗且年龄超过 40 岁、诊断患有 10 种最常见癌症之一的成年患者。数据分析于 2019 年 12 月 19 日至 2020 年 3 月 27 日进行。
医院的平均年患者数量增长率。
主要结局是 TTI，定义为从诊断到首次癌症治疗的天数。使用包含患者数量 × 时间交互作用的线性混合效应模型评估医院平均年度患者数量增长率与 TTI 之间的关系。通过包含医院类型 × 时间交互项来估计研究期间不同医院类型的 TTI 平均年度变化。
研究样本包括 4218577 名患者（平均 [SD] 年龄，65.0 [11.4] 岁；56.6%为女性），在 1351 家医院接受治疗。从 2007 年到 2016 年，NCI 中心的患者数量增长了 40%，学术中心增长了 25%，社区医院增长了 8%。2007 年，NCI 和学术中心的 TTI 平均值长于社区医院（NCI：50 天 [95%CI，48-52 天]；学术：43 天 [95%CI，42-44 天]；社区：37 天 [95%CI，36-37 天]）；然而，社区医院的 TTI 年平均增长率更高（0.56 天；95%CI，0.49-0.62 天），而 NCI 中心的增长率较低（-0.73 天；95%CI，-0.95 至 -0.51 天），学术中心的增长率较低（0.14 天；95%CI，0.03-0.26 天）。每年增长 100 名患者的增长率，这一水平在不到 1%的医院中观察到，与 TTI 平均增加 0.24 天（95%CI，0.18-0.29 天）相关。
在这项横断面研究中，从 2007 年到 2016 年，在所研究的癌症类型中，患者越来越多地在 NCI 和学术中心开始癌症治疗。尽管这些中心的患者数量增长速度超过了社区医院，但更快的增长与临床意义上的治疗延迟无关。
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