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Patients traveling farther for esophageal, pancreatic surgical cancer care

Issue: October 10, 2009

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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.

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.