Natalie J Del Vecchio1, Natoshia M Askelson2, Knute D Carter3, Elizabeth Chrischilles4, Charles F Lynch5, Mary E Charlton5. 1. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA. Electronic address: natalie-delvecchio@uiowa.edu. 2. Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA. 3. Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA. 4. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA. 5. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA; Iowa Cancer Registry, University of Iowa, Iowa City, IA, USA.
Abstract
OBJECTIVE: Despite evidence of volume-outcome relationships for cancer surgery, treatment at low-volume hospitals remains common. Our objective was to evaluate whether individuals actively involved in selecting their cancer surgeon were more likely to go to hospitals recognized for quality cancer care. METHODS: Individuals diagnosed with breast, prostate and colorectal cancer in 2015 completed online surveys in 2017-2018. Participants were categorized as "directed" to a surgeon (relied on referral) or "active" (sought additional information), and hospitals were categorized by NCI-designation, CoC accreditation, and academic affiliation. RESULTS: Of 299 participants, 42% were active. Individuals with breast cancer were more active (aOR = 2.46,95%CI:1.32-4.59). Active participants had nonsignificantly higher odds of surgery at NCI-designated facilities (aOR = 2.04,95%CI:0.95-4.38), or academic centers (aOR = 1.51,95%CI:0.86-2.64). CONCLUSIONS: While most participants were directed to their cancer surgeon, active participants tended to select NCI-designated/academic hospitals. Although centralization of cancer care would require altering referral patterns, decision-support resources may help patients make informed choices.
OBJECTIVE: Despite evidence of volume-outcome relationships for cancer surgery, treatment at low-volume hospitals remains common. Our objective was to evaluate whether individuals actively involved in selecting their cancer surgeon were more likely to go to hospitals recognized for quality cancer care. METHODS: Individuals diagnosed with breast, prostate and colorectal cancer in 2015 completed online surveys in 2017-2018. Participants were categorized as "directed" to a surgeon (relied on referral) or "active" (sought additional information), and hospitals were categorized by NCI-designation, CoC accreditation, and academic affiliation. RESULTS: Of 299 participants, 42% were active. Individuals with breast cancer were more active (aOR = 2.46,95%CI:1.32-4.59). Active participants had nonsignificantly higher odds of surgery at NCI-designated facilities (aOR = 2.04,95%CI:0.95-4.38), or academic centers (aOR = 1.51,95%CI:0.86-2.64). CONCLUSIONS: While most participants were directed to their cancer surgeon, active participants tended to select NCI-designated/academic hospitals. Although centralization of cancer care would require altering referral patterns, decision-support resources may help patients make informed choices.
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