The DOI matches its Crossref record; 35 of the 35 references it cites were found in a registry or an index.
Centralization of Cancer Surgery: Implications for Patient Access to Optimal Care
Open accessAbstract
Purpose: The volume-outcomes relationship has led many to advocate centralization of cancer procedures at high volume hospitals (HVH). We hypothesized that in response cancer surgery has become increasingly centralized and that this centralization has resulted in increased travel burden for patients. Patients and Methods: Using 1996 to 2006 discharge data from NY, NJ, PA, all patients ≥ 18 years old treated with extirpative surgery for colorectal, esophageal, or pancreatic cancer were examined. Patients and hospitals were geocoded. Annual hospital procedure volume for each tumor site was examined, and multiple quantile and logistic regressions were used to compare changes in centralization and distance traveled. Results: Five thousand two hundred seventy-three esophageal, 13,472 pancreatic, 202,879 colon, and 51,262 rectal procedures were included. A shift to HVH occurred to varying degrees for all tumor types. The odds of surgery at a low volume hospital decreased for esophagus, pancreas and colon: per year odds ratios (ORs) were 0.87 (95% CI, 0.85 to 0.90), 0.85 (95% CI, 0.84 to 0.87), and 0.97 (95% CI, 0.97 to 0.98). Median travel distance increased for all sites: esophagus 72%, pancreas 40%, colon 17%, and rectum 28% (P < .0001). Travel distance was proportional to procedure volume (P < .0001). The majority of the increase in distance was attributable to centralization. Conclusion: There has been extensive centralization of complex cancer surgery over the past decade. While this process should result in population-level improvements in cancer outcomes, centralization is increasing patient travel. For some subsets of the population, increasing travel requirements may pose a significant barrier to access to quality cancer care.
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Cites
Hospital Volume and Surgical Mortality in the United States
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Should Operations Be Regionalized?: The Empirical Relation between Surgical Volume and Mortality
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Impact of Hospital Volume on Operative Mortality for Major Cancer Surgery
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Hospital Volume and Late Survival After Cancer Surgery
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Importance of Hospital Volume in the Overall Management of Pancreatic Cancer
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Perioperative Mortality for Pancreatectomy: A National Perspective
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Cited by
Jansen, F., van Uden-Kraan, C. F., van Zwieten, V., Witte, B. I., & Verdonck-de Leeuw, I. M. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-014-2514-7 · Cited by 195
Current epidemiology of cholangiocarcinoma in Western countries
Vithayathil, M., & Khan, S. A. (2022) · Journal of Hepatology · doi:10.1016/j.jhep.2022.07.022 · Cited by 200
Aggarwal, A., Han, L., van der Geest, S., Lewis, D., Lievens, Y., Borras, J., Jayne, D., Sullivan, R., Varkevisser, M., & van der Meulen, J. (2022) · The Lancet Oncology · doi:10.1016/s1470-2045(22)00398-9 · Cited by 42
Katz, M. H. G., Slack, R., Bruno, M., McMillan, J., Fleming, J. B., Lee, J. E., Bednarski, B., Papadopoulos, J., & Matin, S. F. (2016) · Journal of Surgical Research · doi:10.1016/j.jss.2015.12.054 · Cited by 27
Siemens, D. R., Visram, K., Wei, X., & Booth, C. (2019) · Canadian Urological Association Journal · doi:10.5489/cuaj.5998 · Cited by 12
Metadata
- Authors
- Stitzenberg, K. B., Sigurdson, E. R., Egleston, B. L., Starkey, R. B., & Meropol, N. J.
- Venue
- Journal of Clinical Oncology
- Published
- 2009-10-01
- Volume
- 27
- Issue
- 28
- Pages
- 4671-4678
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2057591158
- Cited by
- 455
- References
- 35
- FWCI
- 29.59
- Type
- journal article
- Language
- en
- Open access
- bronze
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