Fragmentation in specialist care and stage III colon cancer

Tanvir Hussain, Hsien Yen Chang, Christine M. Veenstra, Craig Evan Pollack

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: Patients with cancer frequently transition between different types of specialists and across care settings. This study explored how frequently the surgical and medical oncology care of stage III colon cancer patients occurred across more than 1 hospital and whether this was associated with mortality and costs. METHODS: This was a retrospective Surveillance, Epidemiology, and End Results-Medicare cohort study of 9075 stage III colon cancer patients diagnosed between 2000 and 2009 who had received both surgical and medical oncology care within 1 year of their diagnosis. Patients were assigned to the hospital at which they had undergone their cancer surgery and to their oncologist's primary hospital, and then they were characterized according to whether these hospitals were the same or different. Outcomes included all-cause mortality, subhazards for colon cancer-specific mortality, and costs of care at 12 months. RESULTS: Thirty-seven percent of the patients received their surgical and medical oncology care from different hospitals. Rural patients were less likely than urban patients to receive medical oncology care from the same hospital (odds ratio, 0.62; 95% confidence interval, 0.43-0.90). Care from the same hospital was not associated with reduced all-cause or colon cancer-specific mortality but resulted in lower costs (8% of the median cost) at 12 months (dollars saved, $5493; 95% confidence interval, $1799-$9525). CONCLUSIONS: The delivery of surgical and medical oncology care at the same hospital was associated with lower costs; however, reforms seeking to improve outcomes and lower costs through the integration of complex care will need to address the significant proportion of patients receiving care at more than 1 hospital.

Original languageEnglish (US)
Pages (from-to)3316-3324
Number of pages9
JournalCancer
Volume121
Issue number18
DOIs
StatePublished - Sep 1 2015

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Colonic Neoplasms
Medical Oncology
Costs and Cost Analysis
Mortality
Confidence Intervals
Medicare
Neoplasms
Patient Care
Epidemiology
Cohort Studies
Odds Ratio
Surgical Oncology

Keywords

  • colon cancer
  • delivery of health care
  • health care costs
  • integrated health care systems
  • mortality
  • patient care management

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Hussain, T., Chang, H. Y., Veenstra, C. M., & Pollack, C. E. (2015). Fragmentation in specialist care and stage III colon cancer. Cancer, 121(18), 3316-3324. https://doi.org/10.1002/cncr.29474

Fragmentation in specialist care and stage III colon cancer. / Hussain, Tanvir; Chang, Hsien Yen; Veenstra, Christine M.; Pollack, Craig Evan.

In: Cancer, Vol. 121, No. 18, 01.09.2015, p. 3316-3324.

Research output: Contribution to journalArticle

Hussain, T, Chang, HY, Veenstra, CM & Pollack, CE 2015, 'Fragmentation in specialist care and stage III colon cancer', Cancer, vol. 121, no. 18, pp. 3316-3324. https://doi.org/10.1002/cncr.29474
Hussain T, Chang HY, Veenstra CM, Pollack CE. Fragmentation in specialist care and stage III colon cancer. Cancer. 2015 Sep 1;121(18):3316-3324. https://doi.org/10.1002/cncr.29474
Hussain, Tanvir ; Chang, Hsien Yen ; Veenstra, Christine M. ; Pollack, Craig Evan. / Fragmentation in specialist care and stage III colon cancer. In: Cancer. 2015 ; Vol. 121, No. 18. pp. 3316-3324.
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