Women who had breast cancer surgery at a community hospital rated their ability to get the care they needed more favourably than those operated on at a larger regional centre. That is the main finding of a US retrospective study linking cancer registry data with patient experience surveys, and it invites a more nuanced view of the assumption that concentrating breast surgery in high-volume centres improves the patient’s experience of care on its own.
What was known
Evidence on cancer outcomes suggests that high-volume hospitals achieve better results in breast cancer surgery, which has driven referral of surgical care to regional centres. Far less is known about how that referral affects what patients report: access, speed, coordination between services and communication with the doctor. It was also unclear whether the hospital where surgery takes place shapes where the rest of treatment is delivered.
What this study adds
The authors used the SEER-CAHPS dataset, which links the cancer surveillance registry with the survey assessing health plans and providers, among Medicare beneficiaries who had surgery for non-metastatic breast cancer between 2009 and 2019. They mapped care trajectories by combining surgical facility type (regional versus community, a proxy for high and low volume) with the oncologist’s specialty, and applied state sequence analysis. Associations with reported experience were estimated with linear mixed-effects models, testing whether rural residence modified the effect.
Main results
The cohort included 3,327 patients; 15.4% lived in rural areas and 68.8% had surgery at a regional facility. Trajectories showed a clear tendency to receive adjuvant care at the same type of facility where surgery had been performed. Patients operated on at community facilities were significantly more likely to report better experiences with getting needed care (estimate 3.5; 95% CI 0.10-6.9; p = 0.043). No significant differences appeared in getting care quickly, care coordination or doctor communication, and rural residence did not modify the findings.
What it means
The study does not measure cancer outcomes and does not overturn the evidence that higher-volume centres achieve better clinical results: it measures reported experience, another dimension of quality. Its data suggest that facility type matters not only for the operation but because it tends to determine where the rest of treatment is delivered, and that this pathway weighs on the perception of access. For a patient, it is worth knowing the full itinerary in advance, not just the surgical hospital.
A view from the breast unit
Organisationally, centralising surgery without arranging continuity of care can shift the burden onto the patient as travel and paperwork. Breast units that refer to specialist centres can improve this by designing the postoperative pathway, coordinating with medical oncology and radiotherapy, and giving clear information about access.
Reference: Gonzales SR, Ramesh U, O’Malley AJ, et al. Associations of surgical breast cancer treatment at regional or community hospitals with patient-reported experience measures. Breast Cancer Research and Treatment, 2026. DOI
