JCO Oncol Pract. 2023 Aug 17:OP2200851. doi: 10.1200/OP.22.00851. Online ahead of print.
ABSTRACT
PURPOSE: There is strong evidence that hospital volume is associated with improved outcomes for patients undergoing cancer surgery. Lack of access to high-volume hospitals (HVHs) may contribute to rural-urban disparities in cancer outcomes. Yet, methods used to classify hospitals as high-volume vary, making interpretation of evidence on hospital volume complex. This study examines urban-rural differences in receipt of cancer surgery at HVHs and sensitivity to volume thresholds used.
MATERIALS AND METHODS: Using 2017-2020 statewide Pennsylvania Health Care Cost Containment Council inpatient data, we implemented logistic regression models to examine the association between rural residence and cancer surgery at a HVH using different volume thresholds that are commonly used in the literature: top 10%, 20%, 25%, and 30%.
RESULTS: The relationship between rural residence and treatment in a HVH varied by cancer type, and for some cancers, varied in direction, magnitude, or statistical significance, depending on the volume threshold used. Rural patients with cancers of pancreas or esophagus were consistently more likely to receive surgery at HVHs across all four thresholds. For rectum, colon, bladder, lung, and breast cancers, rural patients were consistently less likely to receive surgery at HVHs. For prostate, brain, and stomach cancers, there was less consistency in the relationship between rural residence and treatment.
CONCLUSION: For many cancers, patients residing in rural areas are less likely to receive care at HVHs. Findings highlight the complexity of examining patterns of cancer care at HVHs and can inform efforts to direct patients to HVHs.
PMID:37590899 | DOI:10.1200/OP.22.00851
