Cancer survival vs hospital type

Ruhee Chaudhry and colleagues took a random sample of 938 cases of cancer first diagnosed in 1991, and gathered background information. The researchers were specifically interested in the type of hospital where the patients underwent initial treatment.Out comes were determined by following up vital statistics.

Patients were divided according to demographic variables and tumor specifics. The researchers also studied hospital characteristics, such as the number of beds and the treatment received.

Of 938 patients, 292 (31%) had initial treatment at a teaching hospital and 646 (69%) at a community hospital. Those treated at teaching hospitals were significantly younger and had smaller tumors. Information about tumor grade was missing at some community hospitals.

“Women seen in teaching hospitals were significantly more likely to receive breast-conserving surgery and adjuvant therapy,” says Chaudhry. “They were [also] less likely to be treated by surgery alone.” The therapies included radiation, chemotherapy, and hormone therapy.

After 5 years, the survival rate was 92.5% for those treated in teaching hospitals and 88.7% for those treated in community hospitals.The study also showed a survival advantage for women with small tumors who initially were treated in teaching hospitals. “The difference is not explained by patient characteristics, such as age or socioeconomic status, disease state, or treatment variables,” adds Chaudhry.

The importance of the study lies in identifying possible reasons for the difference. The researchers propose that these reasons include greater use of multidisciplinary teams in the teaching hospitals, along with appropriate adjuvant treatment, closer surveillance and follow-up, and improved supportive care.Teaching hospitals also have more resources available, such as specialized breast pathology, which can assess tumor grades or estrogen receptors.