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

Autor: Charlton ME; 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., Hrabe JE; Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA., Wright KB; Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Room S453 CPHB, Iowa City, IA, 52242, USA., Schlichting JA; Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Room S453 CPHB, Iowa City, IA, 52242, USA., McDowell BD; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA., Halfdanarson TR; Mayo Clinic Cancer Center, Scottsdale, AZ, USA., Lin C; Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA., Stitzenberg KB; Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA., Cromwell JW; Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2016 May; Vol. 20 (5), pp. 1002-11. Date of Electronic Publication: 2015 Dec 09.
DOI: 10.1007/s11605-015-3046-2
Abstrakt: Background: Evidence suggests that high-volume facilities achieve better rectal cancer outcomes.
Methods: 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.
Results: 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.
Conclusions: 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.
Databáze: MEDLINE
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