Does multicenter care impact the outcomes of surgical patients with gastrointestinal malignancies requiring complex multimodality therapy?. Issue 4 (20th June 2020)

• Record Type: Journal Article
• Authors: Shannon, Adrienne B.; Mo, Julia; Song, Yun; Paulson, Emily C.; Roses, Robert E.; Fraker, Douglas L.; Kelz, Rachel R.; Miura, John T.; Karakousis, Giorgos C.
• Is Part Of: Journal of surgical oncology. Volume 122:Issue 4(2020)
• Page Start: 729
• Page End: 738
• Publication Date: 2020-06-20
• Subjects: cancer care facilities -- esophageal cancer -- integrative oncology -- pancreatic cancer -- rectal cancer; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.26075
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background: Regionalization of oncologic care has increased, but less is known whether patient outcomes are influenced by receipt of multimodality care through multicenter care (MCC) or single‐center care (SCC). Methods: Patients from 2004 to 2015 National Cancer Data Base diagnosed with stage II‐III esophageal (EA), stage II‐III pancreatic (PA), and stage II‐IV rectal (RA) adenocarcinoma who underwent resection at a high volume center (HVC) and required radiation and/or chemotherapy were included. MCC (care at 2+ facilities) and SCC patients were propensity‐score matched 1:2 and Cox proportional hazards regression used to analyze survival. Results: On multivariable regression analysis, MCC in RA patients (N = 325/2097, 15.5%) was more associated with residing ≥40 miles from the HVC (odds ratio [OR] = 2.37; P = .044) and receipt of neoadjuvant chemotherapy (1.42, P = .040). In PA patients (N = 75/380, 19.7%), residing ≥40 miles from the HVC (OR = 3.22; P = .001), and in EA patients (N = 88/534, 16.5%), younger patients (<50 years: OR = 2.96; P = .011) were associated with MCC. Following propensity score matching, EA (N = 147), PA (N = 133), and RA (N = 661) patients had no difference in 1‐year and 3‐year overall survival when comparing MCC to SCC. Conclusions: The use of MCC appears safe without a difference in survival and may offer significant advantages in convenience to patients as they undergo their complex oncologic care.