Elsevier

The Lancet

Volume 345, Issue 8960, 20 May 1995, Pages 1265-1270
The Lancet

Influence of clinician workload and patterns of treatment on survival from breast cancer

https://doi.org/10.1016/S0140-6736(95)90924-9Get rights and content

Abstract

Chemotherapy and hormone therapy prolong disease-free and overall survival for patients with breast cancer in the clinical-trial setting, but it is not clear if this translates into a benefit on a population basis. It is also not clear if surgical caseload has any influence on survival. We used cancer-registry data from 12861 patients with breast cancer treated in Yorkshire, UK, between 1979 and 1988, and found that patients of surgeons with higher rates of usage of chemotherapy and hormone therapy (regional mean usage 9·3%, range 0-46%) had prolonged survival. There was considerable variation in survival of breast cancer patients between surgeons, but their rate of use of chemotherapy and hormone therapy explained about 26% of this survival variation. Had the practice of the surgeons with the better outcomes been used by all treating clinicians, 5-year survival would have increased by about 4-5%. Examination of differences in survival as a function of consultant caseload demonstrated poorer results amongst those surgeons treating less than 30 new cases of breast cancer per year (risk ratio [95% Cl] for treating >30 compared with <10=0·85 [0·77-0·93]). We recommend that patients with breast cancer be dealt with only by clinicians who see more than 30 new cases per year and who have a full range of treatment options available within a multidisciplinary setting.

References (18)

  • Cr Gillis et al.

    Medical audit, cancer registration and survival in ovarian cancer

    Lancet

    (1991)
  • F. Berino, M. Sant, A. Verdecchia, R. Capocaccia, T. Hakulinnen, J. Esteve (Eds), Survival for cancer patients in...
  • Jrc Sainsbury et al.

    Does it matter where you live? Treatment variation for breast cancer in Yorkshire

    Br J Cancer

    (1995)
  • Ca Stiller

    Centralisation of treatment and survival rates for cancer

    Arch Dis Child

    (1988)
  • S. Kramer et al.

    Influence of place of treatment on diagnosis, treatment and survival in three paediatric solid tumours

    J Clin Oncol

    (1984)
  • Hr Matthews et al.

    Effects of the results of surgical experience on the results of resection for oesophageal carcinoma

    Br J Surgery

    (1986)
  • Dr Cox

    Regression models and life tables (with discussion)

    J R Stat Soc

    (1972)
  • R. Henderson

    Problems and prediction in survival-data analysis

    Stat Med

    (1955)
There are more references available in the full text version of this article.

Cited by (0)

View full text