Yueh-Han Hsu1, Pei-Tseng Kung2, Shih-Ting Wang3, Chuan-Yin Fang4, Wen-Chen Tsai5. 1. Department of Public Health and Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Liuying, Tainan, Taiwan. Electronic address: jjeelhsu@yahoo.com.tw. 2. Department of Healthcare Administration, Asia University, Taichung, Taiwan. Electronic address: ptkung@asia.edu.tw. 3. Department of Health Services Administration, China Medical University, Taichung, Taiwan. Electronic address: we761220@gmail.com. 4. Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan. Electronic address: 04969@cych.org.tw. 5. Department of Health Services Administration, China Medical University, Taichung, Taiwan. Electronic address: wtsai@mail.cmu.edu.tw.
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.
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 cancerpatients with participation in MDT have a lower mortality risk; the improvements of survival exist in all colorectal cancerpatients, especially in those with stage IV disease.
Authors: Chien-Hsin Chen; Mao-Chih Hsieh; Wilson T Lao; En-Kwang Lin; Yen-Jung Lu; Szu-Yuan Wu Journal: Am J Cancer Res Date: 2018-09-01 Impact factor: 6.166