Cancer study shows some procedures increasingly safer
By Ross Tomlin
While surgeries for six common forms of cancer are being performed more frequently, they are also safer with death rates associated with the surgeries going down in recent years, said a Baylor College of Medicine researcher who spearheaded a study that appeared in a recent issue of Annals of Surgical Oncology.
"Not only have the mortality rates for the different types of cancer rates declined, but hospitals and individual surgeons are performing more of each procedure," said Vivian Ho, Ph.D., associate professor of medicine at Baylor College of Medicine and an expert in the field of health economics. "This is called a volume outcome effect – they're learning how to take care of these patients in a better manner through experience. Practice makes perfect."
Different surgical procedures
The American Cancer Society-funded study tabulated population-based trends in death from six different surgical procedures used to treat various forms of cancer. They surveyed these factors at every hospital in Florida, New York and New Jersey. The procedures included those for colorectal cancer, lung cancer (pulmonary lobectomy and pneumonectomy), pancreatic cancer (Whipple procedure) and throat cancer (esophagectomy). Ho, also the James A. Baker III Institute Chair in health economics at Rice University, co-authored the study with Martin J. Heslin, M.D., Huifeng Yun, M.Sc., and Lee Howard, all of the University of Alabama at Birmingham.
Mortality rates in esophagectomy patients exhibited the largest decline, from 14.5 percent in 1988-91 to 10.5 percent in 1997-2000. On the other hand, lung cancer patients who underwent pulmonary lobectomies declined the least, dropping from 4.1 percent to 3.3 percent over the same period. The number of operations performed overall for those cancers rose during this time.
Centralizing services
Based on her study's findings, Ho believes that centralizing certain health services like cancer surgery – that is, restricting them to sites where many such procedures are performed – would likely result in safer, more efficient and less costly procedures. Along the same lines, she feels that expansion of Certificate of Need regulations, which restrict hospitals from building new facilities or buying new equipment when they cannot prove that there is a community need for them, might also prove beneficial.
"With something like surgery, where there's a large, fixed cost like the operating room, you can spread those fixed costs out over more procedures and have lower costs per operation," said Ho. "If there are economies of scale, we can actually get lower unit costs per procedure, and if that's the case, then it actually slows the rate at which healthcare costs are rising, and that would be important to assess as well."
When hospitals and surgeons make their own decisions about whether or not to perform a certain procedure at a specific facility without regard to volume or experience, Ho's study indicates that some patients may be at risk.
Finding the right healthcare
"These data show that the expected mortality rate for those patients is going to be higher. Is that the right healthcare for patients?" said Ho. "Instead of allowing the surgeon to perform that procedure, there should be guidelines stipulating that a patient should be referred to another surgeon who has more experience or to a hospital where the expected mortality rate is lower."
Evaluation of the cost-benefit ratios in the healthcare world is easier said than done. Drawing accurate conclusions about cancer surgeries requires a large sampling of the wide-ranging patient services, healthcare technology, and skill sets among physicians, said Ho.
"You're not going to find out what's going on in the entire healthcare system if you only look at one particular physician case or hospital," said Ho. "Considering all the differences in particular practices by different surgeons and different hospitals, you need really large samples to get a macro picture of what's going on in terms of mortality through the whole country for cancer surgery patients."
