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. 2019 May;2(3):265-273.
doi: 10.1016/j.euo.2018.10.006. Epub 2018 Nov 5.

Impact of Centralizing Care for Genitourinary Malignancies to High-volume Providers: A Systematic Review

Stephen B Williams  1 , Mohamed D Ray-Zack  2 , Hogan K Hudgins  2 , Jan Oldenburg  3 , Quoc-Dien Trinh  4 , Paul L Nguyen  5 , Neal D Shore  6 , Manfred P Wirth  7 , Timothy O'Brien  8 , James W F Catto  9
Affiliations

Impact of Centralizing Care for Genitourinary Malignancies to High-volume Providers: A Systematic Review

Stephen B Williams et al. Eur Urol Oncol. 2019 May.

Abstract

Context: The centralization of cancer care is associated with better clinical outcomes and may be a method for optimizing value-based health care systems.

Objective: To systematically review the literature regarding the impact of centralization of care on clinical outcomes for genitourinary malignancies.

Evidence acquisition: 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.

Evidence synthesis: 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.

Conclusions: 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.

Patient summary: 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.

Keywords: Cancer; Centralization; Genitourinary; Outcomes; Survival; Urology; Use; Utilization.

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Conflict of interest statement

Financial disclosures: Stephen B. Williams certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

Figures

Fig. 1 –
Fig. 1 –
Consolidated Standards of Reporting Trials diagram outlining the selection process for inclusion of studies.
See this image and copyright information in PMC

Comment in

References

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