A recent trend toward the centralization of cancer surgery at
high-volume hospitals may pose a barrier for patients traveling long distances
to receive quality cancer care.
Researchers examined discharge information from patients who had
esophageal (n=5,273), pancreatic (n=13,472), colon (n=202,879) and rectal
(n=51,262) cancer procedures from 1996 to 2006 at New Jersey, New York and
Pennsylvania area hospitals. Patients were aged 18 years or older.
A shift from low-volume hospitals to high-volume hospitals was observed
for esophageal, pancreatic and colon cancer procedures. Average procedure
volume for the top five high-volume hospitals increased from 36.6 to 60 cases
per year for esophageal cancer and from 62.8 to 125 cases per year for
When adjusted, the annual odds of surgery at a low-volume hospital
decreased for esophageal (OR=0.87; 95% CI, 0.85-0.90) and pancreatic cancer
(OR=0.85; 95% CI, 0.84-0.87). The change in volume was smaller for colon
(OR=0.97; 95% CI, 0.97-0.98) and rectal cancer (OR=1.02; 95% CI, 1.01-1.03).
The number of esophagectomies performed at low-volume hospitals was
reduced from 36% to 14%, and the number of pancreatectomies was reduced from
36% to 12%.
In-hospital mortality was reduced for esophageal resections
(P=.038), pancreatic resections (P=.001) and colon cancer surgery
(P=.002), but was only slightly changed for rectal resections and did
not reach statistical significance (see chart).
The median travel distance increased by 72% for esophagus cancer, 40%
for pancreas cancer, 17% for colon cancer and 28% for rectal cancer
(P< .001 for all). Data showed a causal relationship between
centralization and increasing travel distance for each cancer, according to the
Finally, disparities were observed as patients treated at low-volume
hospitals were more likely to be black; have Medicaid, Medicare or no
insurance; reside in nonmetropolitan areas; and reside in areas with higher
Stitzenberg KB. J Clin Oncol.