Hospital Volume and Quality of Care in Breast Cancer Surgery

• Activity Number: 215
• Type: Contributed
• Date/Time: Tuesday, August 13, 2002 : 12:00 PM to 1:50 PM
• Sponsor: Biometrics Section*
• Author(s): Rodney Sparapani*+
• Affiliation(s): Medical College of Wisconsin
• Keywords: breast cancer ; surgery ; hospital volume ; SEER ; Medicare ; Bayesian

Abstract

Hospital volume is considered to be an important predictor of outcome in many kinds of surgery. We intend to explore this relationship in breast cancer surgery. In breast cancer, there are many other factors that are known to be predictors of survival, such as age, tumor characteristics, comorbidity, and quality of care. Whenever possible, these characteristics need to controlled for.

We will use the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database. SEER is a registry of cancer incidence in five states (CT, IA, HI, NM and UT) and six metropolitan areas (Atlanta, Detroit, Los Angeles, San Francisco/Oakland, San Jose/Monterey and Seattle/Puget Sound).

For about 90% of female breast cancer patients 65 or older who are enrolled in non-HMO Medicare, we know which hospital cared for them from the SEER-Medicare Data Project. However, this is only between a third and a half of the total hospital breast cancer surgery volume. We will explore ways to produce proper statistical inference under these circumstances of uncertainty.