Patients traveling farther for esophageal, pancreatic surgical cancer care

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 pancreatic cancer.

Centralization of Surgery has Decreased In-Hospital Mortality in Some Cancers

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 researchers.

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 poverty.

Stitzenberg KB. J Clin Oncol. 2009;doi:10.1200/JCO.2008.20.1715.

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 pancreatic cancer.

Centralization of Surgery has Decreased In-Hospital Mortality in Some Cancers

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 researchers.

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 poverty.

Stitzenberg KB. J Clin Oncol. 2009;doi:10.1200/JCO.2008.20.1715.