Volume Outcome Project: hospital or clinician volume or specialisation in cancer care

There is an international trend for cancer services to be concentrated in centres that treat high volumes of patients with cancer and offer a full range of cancer services, including surgery, oncology, radiotherapy, and specialised nursing and allied health services. Co-located comprehensive services with vast experience have the potential to provide improved clinical outcomes for some patients when compared with centres that do not have the same level of experience or cannot provide the same services. However, confining cancer services to specialist centres in Australia may adversely affect access to those services for people in outer metropolitan and rural areas. For these reasons, a systematic review of the literature investigating effectiveness of regionalising cancer services to high volume or specialist units is needed to inform evidence based policy decisions.

In September 2005, the Department of Human Services Victoria commissioned the Monash Institute of Health Services Research (MIHSR) to prepare a systematic review investigating the impact of hospital or clinician volume or specialisation in cancer care. This report was conducted as part of the Victorian Government Cancer initiatives in collaboration with the Ministerial Taskforce for Cancer. The project team consisted of staff from MIHSR (Don Campbell and Damien Jolley), the Australasian Cochrane Centre (Sally Green, Veronica Pitt and Silva Zavarsek) and the Menzies School of Health Research (Russell Gruen).

In order to examine the strength and magnitude of the evidence, a detailed systematic review of the evidence of effect of volume by surgeon and hospital and the effect of clinical specialisation upon mortality outcomes (either in-hospital, 30-day or overall mortality) and non-mortality outcomes (including length of stay, complications and type of procedure) was undertaken for ten selected tumour streams: genitourinary cancers, colorectal cancer, breast cancer, lung cancer, skin cancer, haematological cancer, gynaecological cancers, head and neck cancers, upper gastro-intestinal cancers and central nervous system tumours.

Findings of the report have been disseminated as oral presentations at the following conferences:

The report titled Hospital or clinician volume or specialisation in cancer care was completed in June 2006 and submitted to the Cancer and Palliative Care Programs Branch, Department of Human Services Victoria. For further information on other Victorian Government Cancer initiatives and theMinisterial Taskforce for Cancer, see http://www.health.vic.gov.au/cancer/index.htm.

Contact
veronica.pitt@med.monash.edu.au; phone: 03 9594 7512.