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Perspectives on Referring for Rectal Cancer Surgery: a Survey Study of Gastroenterologist and General Surgeons in Iowa

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Abstract

Purpose

To understand referral practices for rectal cancer surgical care and to secondarily determine differences in referral practices by two main hypothesized drivers of referral: the rurality of the community endoscopists’ practice and their affiliation with a colorectal surgeon.

Methods

Community gastroenterologists and general surgeons in Iowa completed a mailed questionnaire on practice demographics, volume, and referral practices for rectal cancer patients. Rurality was operationalized with RUCA codes.

Results

Twenty-two of 53 gastroenterologists (42%) and 120 of 188 general surgeons (64%) (total 144/241, 60%) in Iowa responded. Most performed colonoscopies, including 22 gastroenterologists (100%) and 96 general surgeons (80%). Regular referral of rectal cancer patients to colorectal surgeons was reported for 57% of urban physicians affiliated with a colorectal surgeon, 33% of urban physicians not affiliated with a colorectal surgeon, and 57% and 72% of physicians in large and small rural areas, respectively, who were not affiliated with a colorectal surgeon. High surgeon volume, high hospital volume, and colorectal surgeon specialty were important factors in the referral decisions for over half the physicians. 69% of diagnosing urban general surgeons reported performing rectal cancer surgery about half the time or more, while 85% of small rural and 60% of large rural diagnosing general surgeons reported never or rarely performing rectal cancer surgery.

Conclusions

Diagnosing physicians have variable rectal cancer referral practices, including consistency in referred to surgeon and prioritization of volume and specialization. Prioritizing specialized or high-volume rectal cancer surgical care would require changing existing referring patterns.

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Data Availability

Requests for survey data should be sent to the corresponding author.

Notes

  1. 100-( (8)/(92–18)).

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Acknowledgements

Thank you to the gastroenterologists and general surgeons in Iowa who took the time to complete our survey.

Funding

The study is supported by NIH/NCI contract number HHSN261201800012I/ HHSN26100001 (MEC, SHN, ARK), NIH grant T32 CA 148062 (XG, JE), and NIH/NCI P30 CA086862 (MEC, SHN, ARK).

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Authors and Affiliations

  1. Department of Internal Medicine, The Ohio State University Medical Center, 410 W Tenth Ave, 43210, Columbus, OH, USA

    Kristin S. Weeks

  2. Department of Surgery, University of Iowa Carver College of Medicine, 200 Hawkins Dr, 52242, Iowa City, IA, USA

    Xiang Gao, Jacklyn Engelbart & Imran Hassan

  3. State Health Registry of Iowa, University of Iowa, 2600 UCC, 52242, Iowa City, IA, USA

    Amanda R. Kahl, Sarah H. Nash & Mary E. Charlton

  4. College of Public Health, Department of Epidemiology, University of Iowa, 145 N Riverside Dr, 52242, Iowa City, IA, USA

    Breanna B. Greteman, Sarah H. Nash & Mary E. Charlton

  5. Department of Surgery, University of North Carolina at Chapel Hill, 101 Manning Drive, 27599, Chapel Hill, NC, USA

    Muneera R. Kapadia

Authors
  1. Kristin S. Weeks
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  2. Xiang Gao
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  3. Amanda R. Kahl
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  4. Jacklyn Engelbart
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  5. Breanna B. Greteman
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  6. Imran Hassan
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  7. Muneera R. Kapadia
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  8. Sarah H. Nash
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  9. Mary E. Charlton
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Contributions

All authors contributed to data analysis and interpretation, critical revision of the manuscript, and final approval / accountability of the manuscript. Kristin Weeks, Xiang Gao, Amanda Kahl, and Mary Charlton contributed to study design and data acquisition. Kristin Weeks completed the first draft.

Corresponding author

Correspondence to Mary E. Charlton.

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Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University of Iowa.

Competing Interests

The authors declare no competing interests.

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Weeks, K., Gao, X., Kahl, A.R. et al. Perspectives on Referring for Rectal Cancer Surgery: a Survey Study of Gastroenterologist and General Surgeons in Iowa. J Gastrointest Canc (2023). https://doi.org/10.1007/s12029-023-00998-1

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