Journal article
Predictors of rectal cancer resection at high-volume hospitals among Medicare patients
Journal of clinical oncology, Vol.36(4_suppl), pp.808-808
02/01/2018
DOI: 10.1200/JCO.2018.36.4_suppl.808
Abstract
808 Background: Hospitals that perform high volumes of rectal cancer resections achieve superior rates of sphincter preservation and survival compared to those that do not, but many rectal cancer resections are still performed in low-volume centers. We aimed to determine the patient, provider and pathway characteristics associated with receipt of surgery from high-volume hospitals. Methods: Patient and provider characteristics were extracted from the SEER-Medicare database for Medicare beneficiaries (age 66+) with stage II/III rectal adenocarcinoma diagnosed 2007-2011 who received rectal cancer-directed surgery. Hospitals were divided into quartiles by volume of rectal cancer resections, and were also classified by NCI cancer center designation. Results: 2056 patients were included, and 57% received surgery in a high-volume hospital or NCI-designated center. Those residing in census tracts classified as rural and having higher median incomes, lower poverty, and higher levels of education more frequently received surgery in high-volume hospitals; there were no differences by age, gender, stage, or co-morbidity status. 55% of patients received surgery at the same facility where they received the colonoscopy that identified their cancer. In multivariate analyses, the strongest predictor of receiving one’s surgery in a high-volume hospital was receipt of colonoscopy at a high-volume facility (OR = 3.75, 95% CI: 2.93-4.79). Those treated in high-volume hospitals more often had guideline-recommended staging (TRUS/MRI) and treatment (neoadjuvant chemoradiation). Conclusions: Rectal cancer patients tended to stay at the facility where their cancer was diagnosed; and did not typically seek out high-volume providers if their colonoscopy was performed in a low-volume facility. This suggests that colonoscopists may have substantial influence over where patients receive surgery. Given that rurality, income and education appear to more strongly predict receipt of surgery at a high-volume hospital compared to clinical characteristics, further research is needed to understand considerations driving patient decisions and referring providers’ recommendations for care.
Details
- Title: Subtitle
- Predictors of rectal cancer resection at high-volume hospitals among Medicare patients
- Creators
- Mary E Charlton - University of Iowa College of Public Health, Iowa City, IACatherine Chioreso - University of Iowa College of Public Health, Iowa City, IAIrena Gribovskaja-Rupp - University of Iowa Carver College of Medicine, Iowa City, IAChi Lin - University of Nebraska Medical Center, Omaha, NEMarcia M Ward - University of Iowa College of Public Health, Iowa City, IACharles F Lynch - University of Iowa, Iowa City, IAElizabeth A Chrischilles - University of Iowa College of Public Health, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.36(4_suppl), pp.808-808
- DOI
- 10.1200/JCO.2018.36.4_suppl.808
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Language
- English
- Date published
- 02/01/2018
- Academic Unit
- Pharmacy; Epidemiology; Health Management and Policy; Surgery
- Record Identifier
- 9984213372302771
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