BACKGROUND: @entity43 ( @entity43 ) requires complex multidisciplinary care with wide variations in outcome. We sought to determine the impact of institutional and process of care factors on @entity1349 ( @entity1349 ) and delivery of guideline care nationally. METHODS: This was a retrospective cohort study of primary @entity43 diagnosed from 1998 to 2007 using the National Cancer Data Base (NCDB) capturing 80% of all U.S. cases. @entity1 - (demographics, comorbidities, stage/grade), process of care (adherence to guidelines) and institutional- (facility type, case volume) factors were evaluated. Primary outcomes were @entity1349 and delivery of guideline therapy. Multivariable logistic regression and Cox proportional hazards models were used for analysis. RESULTS: We analyzed 96,802 consecutive cases. Five-year @entity1349 was 84%, 66.3%, 32% and 15.7% for stages I, II, III and IV, respectively. The annual mean facility case volumes varied by @entity5 center type (range: 5.7 to 26.7), with 25% of cases spread over 65% of centers - all treating fewer than 8 cases. Overall, 56% of cases received non-guideline care. Low facility case volume and higher comorbidity index independently predicted non-guideline care; high volume centers were less likely to deliver non-guideline care (OR: 0.44, 95% CI: 0.41-0.47). Delivery of non-guideline care (OR: 1.4, 95% CI: 1.36-1.44), and higher facility case volume (OR: 0.91, 95% CI: 0.86-0.96) were both independent predictors of @entity1349 . CONCLUSIONS: Delivery of guideline care and facility case volume are important drivers of @entity1349 . Most @entity5 centers treat very few @entity1 with @entity43 . National efforts should focus on improved access to centers with expertise in @entity43 and ensuring delivery of guideline care.

XXXX in the United States: Contemporary patterns of care associated with improved survival.

@entity43 :: ('MESH:D010051', 'Disease') :: ['OC', 'Ovarian cancer'] @entity1 :: ('9606', 'Species') :: ['women', 'Patient'] @entity5 :: ('MESH:D009369', 'Disease') :: ['cancer'] @entity1349 :: ('MESH:D011475', 'Disease') :: ['OS', 'overall survival']
@entity43 :: (MESH:D010051,Disease) :: ['Ovarian cancer']
