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November 25, 1998

Hospital Volume and Patient Outcomes in Major Cancer Surgery: A Catalyst for Quality Assessment and Concentration of Cancer Services

Author Affiliations

From the Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond.

JAMA. 1998;280(20):1783-1785. doi:10.1001/jama.280.20.1783

What can physicians do today about the cancer burden? The managed care industry has principally focused on early detection of breast, cervical, and colorectal cancers. Cancer professional organizations have pushed to expand access to research trials and experimental therapy. The role of genetic screening is also hotly debated.

However, relatively little attention has been given to the actual care provided to patients with cancer. In other words, does it matter where patients live, what type of insurance coverage they have, what their physician's specialty is, and at what type of medical center they are being treated or what its volume of cases is for a specific cancer? With the prominent exception of factors associated with breast-conserving surgery and local radiation compared with mastectomy for early stage breast cancer, the answer is the US health care system does not know and has not even tried to look (B.E.H. and T. J.S., unpublished data, 1998).