Journal article
Patterns of Care and Outcomes of Rectal Cancer Patients from the Iowa Cancer Registry: Role of Hospital Volume and Tumor Location
Journal of gastrointestinal surgery, Vol.27(6), pp.1228-1237
06/2023
DOI: 10.1007/s11605-023-05656-2
PMCID: PMC11283177
PMID: 36949239
Abstract
BackgroundCentralization of rectal cancer surgery has been associated with high-quality oncologic care. However, several patient, disease and system-related factors can impact where patients receive care. We hypothesized that patients with low rectal tumors would undergo treatment at high-volume centers and would be more likely to receive guideline-based multidisciplinary treatment.MethodsAdults who underwent proctectomy for stage II/III rectal cancer were included from the Iowa Cancer Registry and supplemented with tumor location data. Multinomial logistic regression was employed to analyze factors associated with receiving care in high-volume hospital, while logistic regression for those associated with >= 12 lymph node yield, pre-operative chemoradiation and sphincter-preserving surgery.ResultsOf 414 patients, 38%, 39%, and 22% had low, mid, and high rectal cancers, respectively. Thirty-two percent were > 65 years, 38% female, and 68% had stage III tumors. Older age and rural residence, but not tumor location, were associated with surgical treatment in low-volume hospitals. Higher tumor location, high-volume, and NCI-designated hospitals had higher nodal yield (>= 12). Hospital-volume was not associated with neoadjuvant chemoradiation rates or circumferential resection margin status. Sphincter-sparing surgery was independently associated with high tumor location, female sex, and stage III cancer, but not hospital volume.ConclusionsLow tumor location was not associated with care in high-volume hospitals. High-volume and NCI-designated hospitals had higher nodal yields, but not significantly higher neoadjuvant chemoradiation, negative circumferential margin, or sphincter preservation rates. Therefore, providing educational/quality improvement support in lower volume centers may be more pragmatic than attempting to centralize rectal cancer care among high-volume centers.
Details
- Title: Subtitle
- Patterns of Care and Outcomes of Rectal Cancer Patients from the Iowa Cancer Registry: Role of Hospital Volume and Tumor Location
- Creators
- P. Goffredo - University of MinnesotaA. A. Hart - Univ Iowa, Dept Surg, Carver Coll Med, Iowa City, IA 52242 USAC. G. Tran - Univ Iowa, Dept Surg, Carver Coll Med, Iowa City, IA 52242 USAA. R. Kahl - Univ Iowa, Dept Epidemiol, Coll Publ Hlth, Iowa City, IA USAX. Gao - Univ Iowa, Dept Surg, Carver Coll Med, Iowa City, IA 52242 USAN. J. Del Vecchio - Fred Hutchinson Canc Res Ctr, Div Publ Hlth Sci, Seattle, WA USAM. E. Charlton - Univ Iowa, Dept Epidemiol, Coll Publ Hlth, Iowa City, IA USAI. Hassan - Univ Iowa, Dept Surg, Carver Coll Med, Iowa City, IA 52242 USA
- Resource Type
- Journal article
- Publication Details
- Journal of gastrointestinal surgery, Vol.27(6), pp.1228-1237
- DOI
- 10.1007/s11605-023-05656-2
- PMID
- 36949239
- PMCID
- PMC11283177
- NLM abbreviation
- J Gastrointest Surg
- ISSN
- 1091-255X
- eISSN
- 1873-4626
- Publisher
- Springer Nature
- Number of pages
- 10
- Grant note
- HHSN261201800012I/HHSN26100001; 1K07CA197067; T32 CA 148062 / NIH/NCI; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) P30 CA086862 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Language
- English
- Electronic publication date
- 03/22/2023
- Date published
- 06/2023
- Academic Unit
- Epidemiology; Pharmaceutical Sciences and Experimental Therapeutics; Surgery
- Record Identifier
- 9984388651302771
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