Improved patient survivals with colorectal cancer under multidisciplinary team care: A nationwide cohort study of 25, 766 patients in Taiwan. Issue 6 (June 2016)

• Record Type: Journal Article
• Authors: Hsu, Yueh-Han; Kung, Pei-Tseng; Wang, Shih-Ting; Fang, Chuan-Yin; Tsai, Wen-Chen
• Is Part Of: Health policy. Volume 120:Issue 6(2016)
• Page Start: 674
• Page End: 681
• Publication Date: 2016-06
• Subjects: Colorectal cancer -- Multidisciplinary team care -- Propensity score method -- Quality of care -- Service volume -- Survival; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2016.04.001
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: We provide solid evidence that patients of colorectal cancer (CRC) have better survivals under multidisciplinary team (MDT) care model. We use propensity score method to reduce potential bias and enhance the credibility of the research. Patients with stage IV CRC or aged have best improvement of survival, which provides an encouraging evidence to take an aggressive attitude to treatments. We recommend policy maker to provide stronger incentives for patients of advanced stage to receive MDT care model rather than refusing therapy. Abstract: Objectives: The evidence of improved survival in patients of colorectal cancer (CRC) receiving multidisciplinary team (MDT) care remains inconclusive. Methods: All patients with incident CRC but no prior cancer history in 2005–2008 were included and followed till 2010. A logistic regression model was used to predict the associated factors to participate in the MDT care model. The propensity score method was included under Cox proportional hazards model to reduce potential bias and to conduct survival analyses. Results: In total, 25, 766 patients were included; the mean follow-up period was 35.1 months. The factors associated with participating in MDT included receiving treatments at regional hospitals, at private hospitals, and stage III cancer (all p values <0.001). The favorable survival factors included participating in MDT (HR = 0.91, p = 0.001), age of 45–75, top-ranked income group, receiving treatments at district hospitals, or at hospitals or with doctors that had higher service volumes (all p values <0.05). Regarding individual stages, the risk of mortality was significantly lower at stage IV (HR = 0.88, p = 0.002). Conclusion: Colorectal cancer patients with participation in MDT have a lower mortality risk; the improvements of survival exist in all colorectal cancer patients, especially in those with stage IV disease.