Hospital Characteristics Associated with Stage II/III Rectal Cancer Guideline Concordant Care: Analysis of Surveillance, Epidemiology and End Results-Medicare Data

Mary E Charlton; Jennifer E Hrabe; Kara B Wright; Jennifer A Schlichting; Bradley D McDowell; Thorvardur R Halfdanarson; Chi Lin; Karyn B Stitzenberg; John W Cromwell

doi:10.1007/s11605-015-3046-2

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Hospital Characteristics Associated with Stage II/III Rectal Cancer Guideline Concordant Care: Analysis of Surveillance, Epidemiology and End Results-Medicare Data

Journal article

Peer reviewed

Hospital Characteristics Associated with Stage II/III Rectal Cancer Guideline Concordant Care: Analysis of Surveillance, Epidemiology and End Results-Medicare Data

Mary E Charlton, Jennifer E Hrabe, Kara B Wright, Jennifer A Schlichting, Bradley D McDowell, Thorvardur R Halfdanarson, Chi Lin, Karyn B Stitzenberg and John W Cromwell

Journal of gastrointestinal surgery, Vol.20(5), pp.1002-1011

05/2016

DOI: 10.1007/s11605-015-3046-2

PMCID: PMC7332110

PMID: 26658793

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Abstract

Evidence suggests that high-volume facilities achieve better rectal cancer outcomes. Logistic regression was used to evaluate association of facility type with treatment after adjusting for patient demographics, stage, and comorbidities. SEER-Medicare beneficiaries who were diagnosed with stage II/III rectal adenocarcinoma at age ≥66 years from 2005 to 2009 and had Parts A/B Medicare coverage for ≥1 year prediagnosis and postdiagnosis plus a claim for cancer-directed surgery were included. Institutions were classified according to National Cancer Institute (NCI) designation, presence of residency program, or medical school affiliation. Two thousand three hundred subjects (average age = 75) met the criteria. Greater proportions of those treated at NCI-designated facilities received transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI)-pelvis (62.1 vs. 29.9 %), neoadjuvant chemotherapy (63.9 vs. 41.8 %), and neoadjuvant radiation (70.8 vs. 46.3 %), all p < 0.0001. On multivariate analysis, odds ratios (95 % confidence intervals) for receiving TRUS or MRI, neoadjuvant chemotherapy, or neoadjuvant radiation among beneficiaries treated at NCI-designated facilities were 3.51 (2.60-4.73), 2.32 (1.71-3.16), and 2.66 (1.93-3.67), respectively. Results by residency and medical school affiliation were similar in direction to NCI designation. Those treated at hospitals with an NCI designation, residency program, or medical school affiliation received more guideline-concordant care. Initiatives involving provider education and virtual tumor boards may improve care.

Morbidity - trends

Rectal Neoplasms - diagnosis

United States - epidemiology

SEER Program

Hospitals - standards

Survival Rate - trends

Medicare

Humans

Male

Rectal Neoplasms - epidemiology

Rectal Neoplasms - therapy

Adenocarcinoma - diagnosis

Guideline Adherence

Adenocarcinoma - therapy

Aged, 80 and over

Female

Neoadjuvant Therapy

Aged

Adenocarcinoma - epidemiology

Neoplasm Staging

Odds Ratio

Details

Title: Subtitle: Hospital Characteristics Associated with Stage II/III Rectal Cancer Guideline Concordant Care: Analysis of Surveillance, Epidemiology and End Results-Medicare Data
Creators: Mary E Charlton - Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Room S453 CPHB, Iowa City, IA, 52242, USA. mary-charlton@uiowa.edu
Jennifer E Hrabe - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Kara B Wright - Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Room S453 CPHB, Iowa City, IA, 52242, USA
Jennifer A Schlichting - Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Room S453 CPHB, Iowa City, IA, 52242, USA
Bradley D McDowell - Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
Thorvardur R Halfdanarson - Mayo Clinic Cancer Center, Scottsdale, AZ, USA
Chi Lin - Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
Karyn B Stitzenberg - Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
John W Cromwell - Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Resource Type: Journal article
Publication Details: Journal of gastrointestinal surgery, Vol.20(5), pp.1002-1011
DOI: 10.1007/s11605-015-3046-2
PMID: 26658793
PMCID: PMC7332110
NLM abbreviation: J Gastrointest Surg
ISSN: 1091-255X
eISSN: 1873-4626
Publisher: United States
Grant note: P30 CA086862 / NCI NIH HHS
Language: English
Date published: 05/2016
Academic Unit: Health Management and Policy; Epidemiology; Surgery; Holden Comprehensive Cancer Center
Record Identifier: 9983996188902771

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