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Longitudinal analyses of cancer registries provide an opportunity for population-based explanations of epidemiology and survival-related outcomes. This study used two population-based data sets to report on nine surgery-related cancers over the past three decades.Using the SEER cancer database (1973–1999), all patients (>18 years old) with adenocarcinoma of esophagus, gastric, biliary system, pancreas, small bowel, colon, rectum; esophageal squamous cell carcinoma (ESC), or hepatocellular (HCC) carcinoma (n = 379,640) were analyzed. Changes in incidence rates, stage at diagnosis, and 5-year cancer and stage-specific survivals were determined. A separate database, the California inpatient database (1990–2000), was concurrently used to evaluate inpatient mortality after surgical resection (n = 34,057).Incidence rates increased for three cancers (esophageal, HCC, small bowel); decreased for three (rectal, gastric, ESC); and stayed constant for three (biliary, pancreatic, colon). More patients presented with local/regional disease in the 1990s versus 1970s for eight tumors (except small bowel, P < 0.05). Five-year overall survival improved for all but small bowel (P < 0.05); and local stage survival was improved for all except small bowel and biliary (P < 0.05). Finally, inpatient mortality rates improved significantly for liver, esophageal, pancreatic, and gastric resections (P < 0.05) over the past decade.For these nine surgically treated cancers, we are detecting disease at earlier and therefore more treatable stages, and surgical care and outcomes also appear to have improved. Continued reexamination of longitudinal trends of surgically relevant outcomes is important for future improvement of surgical care. [Copyright &y& Elsevier]

: BackgroundUnderstanding the quality of life and health utility for cancer survivors is important; however, little data are available—particularly for long-term (>5 year) survivors. Using “health utility” scores as a proxy for quality of life may be advantageous because it is a single value. Utility scores range from 1.0 (perfect health) to 0 (death), and have been shown to be a good numerical summary of overall quality of life. Using a validated instrument for health utility (HALex), we calculated and report the scores of four different surgical cancers at multiple periods of follow-up, ranging from <1 year to >5 years after diagnosis.: MethodsPatients diagnosed with either breast, colon, melanoma, or lung cancer were studied using the 1998 National Health Information Survey. Responses to several validated questions were collected and health utility scores were calculated. Different time periods were measured; acute (<1 year), short term (1–5 years), and long term (>5 years). Once a single health utility score was calculated, multivariate analyses were performed to identify important predictors of better versus worse health utility scores.: ResultsThe total sample size was 692 (breast 377, colon 169, melanoma 92, lung 54). Mean ages at diagnosis for the cancer groups were 56, 61, 52, and 60 years, respectively. The mean health utility scores in the acute period after diagnosis were: breast 0.62, colon 0.67, melanoma 0.73, and lung 0.42. In this acute period, the mean utility score for lung cancer survivors was statistically lower versus the others in the acute period (P < 0.001). Although variable trends were noted in the short-term period, all cancers demonstrated an increase in mean scores in the long-term period; the percent increases were: breast 15% (P = 0.01), colon 12%, melanoma 7%, and lung 47%. Multivariate regression analyses identified important associations of health utility scores. Significant predictors of lower health utility included the presence of pain and the presence of co-existent diseases, most commonly joint problems, cardiovascular disease, and diabetes.: ConclusionsFor four surgical cancers in three time periods after diagnosis, health utility scores were lowest immediately after treatment and improved over time. Long-term (>5 year) survivors had the highest scores. Additionally, our analyses show that a part of health utility in this cohort is determined by the presence of pain and co-existent diseases, which are often items that can be improved by quality clinical care. [Copyright &y& Elsevier]

: IntroductionPrevious studies have suggested that young breast cancer patients have poorer survival as compared with their older counterparts. Most of this research reflects single institution experiences that may not be representative of the population. This study was designed to determine whether young breast cancer patients have poorer survival as compared with an older cohort using a national population-based cancer registry and, more specifically, to determine whether differences in survival are caused by more advanced tumor stage, more aggressive disease, or patient-specific characteristics.: Materials and methodsUsing the Surveillance, Epidemiology, and End Results cancer database (1992–1998), data for all patients with a diagnosis of invasive breast cancer were extracted. Two age categories were analyzed: young group (≤35 years old, n = 4,616) and older group (50–55 years old, n = 20,319). Patient demographics, 5-year survival rates, tumor characteristics (stage, grade, and receptor status), surgical treatment, and use of radiation were compared between the groups.: ResultsOverall, young patients had worse 5-year survival when compared with the older group (74.3% vs. 85.1%). Stage for stage, the young patients also had poorer survival (except for stage IV). They present with more advanced stage disease and have more aggressive tumor characteristics, that is, higher grade tumors and more estrogen- and progesterone receptor-negative tumors. Even after controlling for patient characteristics, tumor factors, and receipt of treatment, a multivariate regression showed that young age was an independent risk factor for death (HR = 1.095).: ConclusionsYoung breast cancer patients have poorer outcomes, which are in part attributed to later stage disease, more aggressive tumors, and less favorable receptor status. There still appears to be other important factors, not included in our study, that are contributing to the worse outcomes for these young patients, such as socioeconomic status. Physicians need to have heightened awareness when evaluating this population, and increasingly efficacious adjuvant therapies need to be developed. [Copyright &y& Elsevier]

Abstract: Objective: Determine if racial/ethnic disparities exist for access to high-volume surgeons (HVS) for patients with ovarian cancer. Methods: Retrospective study of ovarian cancer surgeries identified by the California Cancer Registry (CCR) linked to hospital discharge data (1991–2002). Surgeon volume was defined as HVS (>10 ovarian cancer surgeries/year), middle volume (MVS; 2–9/year), and low volume (LVS; ≤1/year). Multivariate ordered logistic regression predicting surgeon volume provided estimates of relative risk (RR) of surgeon volume by patient race/ethnicity. Results: 13,186 women had ovarian cancer (mean age 57.8 years; 72% non-Hispanic White (NHW), 4% Black, 8% Hispanic). 25% of cases were treated by HVS, 31% by MVS, and 44% by LVS. Compared to NHW, Black (RR: 0.70, p <0.05) and Hispanic women (RR: 0.75, p <0.05) were less likely to have care by a HVS. Hispanic women were significant more likely to have surgery by LVS (RR: 1.1; p <0.05). Conclusions: Disparities in access to HVS for cancer care exist for minority women. Selective referral to high-volume providers should be considered to improve outcomes among minority women. [Copyright &y& Elsevier]

Background: Chart abstraction is a common method for measuring the quality of surgical care. In this study we examine how the use of standardized operative dictation and history forms improves documentation rates of bariatric quality measures. Materials and methods: Two independent reviewers evaluated 201 patient charts from two multi-surgeon bariatric surgery practices for documentation of five intraoperative and seven preoperative bariatric quality measures. Group 1 used fully standardized templates to dictate or collect both, while Group 2 did not. Documentation rates were compared between the groups. Results: Operative reports more consistently documented quality assessment information for cases where a dictation template was used versus where it was not (89% versus 58%, respectively, P < 0.001). The greatest discrepancies between the two groups were found in “exploration of the abdomen” (95% in Group 1 versus 43% in Group 2, P < 0.001) and in “evaluation of the gallbladder” (76% versus 28%, P < 0.001). In comparison, overall documentation rates for preoperative comorbidities were greater in both groups but remained higher for Group 1, who used fully standardized forms (98% versus 74%, P < 0.001). Group 1 had statistically significant higher rates of documentation for all seven comorbidities. Conclusions: The use of standardized dictation templates and history forms is associated with significantly higher documentation rates of quality measures in bariatric surgery. The adoption of these methods into routine use will be needed to allow for wide scale quality assessment and improvement for surgical practices. [Copyright &y& Elsevier]

: BackgroundMany studies have demonstrated a significant relationship between high procedural volume and better outcomes. As the public becomes increasingly aware of this medical literature, consumer groups have collaborated with medical researchers to operationalize this body of evidence. One such organization, the Leapfrog Group, has proposed annual volume criteria for four operations: coronary bypass grafting (CABG), abdominal aortic aneurysm (AAA), carotid endarterectomy (CEA), and esophageal cancer resection (ECR). This study analyzes California hospitals within the context of these volume criteria.: Materials and methodsUsing the California inpatient database from 2000, we identified all CABG, AAA, CEA, and ECR operations performed at metropolitan hospitals. The volume of each of the four operations was tabulated by hospital and evaluated. Comparisons were made between academic and nonacademic hospitals.: ResultsMost hospitals in California did not meet Leapfrog''s volume criteria. Only 2 hospitals of 287 (0.7%) met the volume criteria for the operations that it performed. Of the 71 (25%) hospitals that performed all four procedures, none met the volume criteria of all four procedures. In fact, only 10% of California hospitals performing these operations were high-volume hospitals based on Leapfrog''s volume criteria. When comparing academic to nonacademic hospitals, academic hospitals performed more AAA operations than nonacademic hospitals (36 vs 12, P = 0.02). Although academic hospitals tended to have higher caseloads for CABG, CEA, and ECR, these did not reach statistical significance. Also, academic hospitals were more likely to be high volume for AAA (43.8% vs 7.0%, P < 0.01) and for ECR (23.1% vs 4.0%, P < 0.01).: ConclusionsCalifornia''s hospital system is far from being regionalized. Although academic hospitals appear better positioned than nonacademic hospitals, the vast majority of all hospitals do not meet Leapfrog''s volume criteria. As efforts to use volume as a proxy measure of quality gain momentum, hospitals and physicians will be forced to measure and report quality. As such, surgeons need to decide between accepting volume as an adequate measure of quality and developing other possibly more direct and reliable methods. [Copyright &y& Elsevier]