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Does practice make perfect?

Hogan AM, Winter DC - Ann. Surg. Oncol. (2008)

Bottom Line: It is this evidence that has catalysed the creation of centres of excellence.We critically appraise the English language literature published over the last ten years pertaining to the volume outcome relationship in the context of cancer care.Future balanced unbiased studies may enable equipoise in planning international cancer management strategies.

View Article: PubMed Central - PubMed

Affiliation: Institute of Clinical Outcomes in Research and Education (ICORE), St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.

ABSTRACT
Extensive literature supports the correlation between surgical volume and improved clinical outcome in the management of various cancers. It is this evidence that has catalysed the creation of centres of excellence. However, on closer inspection, many of these studies are poor quality, low weight and use vastly heterogenous end points in assessment of both volume and outcome. We critically appraise the English language literature published over the last ten years pertaining to the volume outcome relationship in the context of cancer care. Future balanced unbiased studies may enable equipoise in planning international cancer management strategies.

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Related in: MedlinePlus

Volume–outcome relationship.
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Related In: Results  -  Collection


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Fig1: Volume–outcome relationship.

Mentions: More often than not, within a short period of the introduction of a new service, its resources are saturated. At what point does a dedicated unit declare that available services can no longer provide for patient throughput? The worry is that potential exists for patients to receive suboptimal care just before this saturation point is reached (Fig. 1). Surely stretched resources in a high-volume centre are just as dangerous as absence of resources in smaller institution. A study on the difference in time lapse between diagnosis and intervention between institutions with different volumes would be welcome. Would prognosis be improved if a patient with aggressive disease underwent early intervention at a lower-volume centre rather than late intervention at a higher-volume centre? As cancer management is a dynamic process, the question of safety in transferring postoperative follow-up of a patient operated on in a high-volume unit to a less experienced lower-volume local centre is a pertinent one. On the other hand, should surgery be performed in low-volume units and adjuvant therapies in specialist centres? Without a doubt, the idea of hospital units functioning as a syncitium rather than single buildings must be engendered and skill-appropriate tasks assigned to each component, as recommended in breast cancer management by the Clinical Oncology Information Network (COIN) group.18Fig. 1.


Does practice make perfect?

Hogan AM, Winter DC - Ann. Surg. Oncol. (2008)

Volume–outcome relationship.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2277451&req=5

Fig1: Volume–outcome relationship.
Mentions: More often than not, within a short period of the introduction of a new service, its resources are saturated. At what point does a dedicated unit declare that available services can no longer provide for patient throughput? The worry is that potential exists for patients to receive suboptimal care just before this saturation point is reached (Fig. 1). Surely stretched resources in a high-volume centre are just as dangerous as absence of resources in smaller institution. A study on the difference in time lapse between diagnosis and intervention between institutions with different volumes would be welcome. Would prognosis be improved if a patient with aggressive disease underwent early intervention at a lower-volume centre rather than late intervention at a higher-volume centre? As cancer management is a dynamic process, the question of safety in transferring postoperative follow-up of a patient operated on in a high-volume unit to a less experienced lower-volume local centre is a pertinent one. On the other hand, should surgery be performed in low-volume units and adjuvant therapies in specialist centres? Without a doubt, the idea of hospital units functioning as a syncitium rather than single buildings must be engendered and skill-appropriate tasks assigned to each component, as recommended in breast cancer management by the Clinical Oncology Information Network (COIN) group.18Fig. 1.

Bottom Line: It is this evidence that has catalysed the creation of centres of excellence.We critically appraise the English language literature published over the last ten years pertaining to the volume outcome relationship in the context of cancer care.Future balanced unbiased studies may enable equipoise in planning international cancer management strategies.

View Article: PubMed Central - PubMed

Affiliation: Institute of Clinical Outcomes in Research and Education (ICORE), St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.

ABSTRACT
Extensive literature supports the correlation between surgical volume and improved clinical outcome in the management of various cancers. It is this evidence that has catalysed the creation of centres of excellence. However, on closer inspection, many of these studies are poor quality, low weight and use vastly heterogenous end points in assessment of both volume and outcome. We critically appraise the English language literature published over the last ten years pertaining to the volume outcome relationship in the context of cancer care. Future balanced unbiased studies may enable equipoise in planning international cancer management strategies.

Show MeSH
Related in: MedlinePlus