The centralization of cancer care is associated with better clinical outcomes and may be a method for optimizing value-based health care systems.
To systematically review the literature regarding the impact of centralization of care on clinical outcomes for genitourinary malignancies.
A systematic review was conducted using Ovid and MEDLINE to identify studies between 1970 and 2018 reporting on the centralization of care for genitourinary malignancies. Prospective and retrospective studies were screened.
There were no published randomized control trials (RCTs) on the centralization of care for genitourinary malignancies. Twenty-two retrospective studies met inclusion criteria. Centralization of radical cystectomy was the most studied. Care for bladder cancer, prostate cancer, penile cancer, testicular cancer, and renal cancer was reportedly associated with better morbidity and survival outcomes for patients treated at high-volume centers. However, evidence of better outcomes for centralization of care remains limited for penile, renal, and testicular cancers owing to the paucity of data and/or the lower incidence of these genitourinary malignancies.
Care for genitourinary malignancies by high-volume providers was associated with greater utilization of cancer surgery, lower morbidity, and better survival outcomes. Centralization of care was most appropriate for complex procedures such as radical cystectomy when interpreted in the context of survival outcomes. Further research is needed to address the impact of centralizing care for all urologic malignancies with consideration of the associated costs and patient-reported measures, including quality of life and patient experience.
We explored the evidence for moving major operations into larger centers. We focused on surgery for cancers of the bladder, prostate, testicle, penis, and kidney, and found that larger-volume hospitals had better survival outcomes and fewer complications when compared to smaller hospitals. The difference may be greatest for complex major surgeries such as radical cystectomy.
European urology oncology. 2018 Nov 05 [Epub]
Stephen B Williams, Mohamed D Ray-Zack, Hogan K Hudgins, Jan Oldenburg, Quoc-Dien Trinh, Paul L Nguyen, Neal D Shore, Manfred P Wirth, Timothy O'Brien, James W F Catto
Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA. Electronic address: ., Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA., Department of Oncology, Akershus University Hospital, Lørenskog, Norway., Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA., Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany., Guy's and St. Thomas' NHS Foundation Trust, London, UK., Academic Urology Unit, University of Sheffield, Sheffield, UK.