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Effect of Hospital Cancer Designation on use of Multimodal Therapy and Survival of Metastatic Colorectal Cancer: A State-Wide Analysis

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Abstract

Background

Stage IV colorectal cancer (CRC) often requires multidisciplinary approach. However, multimodal treatment options (receipt of > 1 type of treatment) may not be uniformly delivered across health systems. We characterized the association between center-level cancer center designation and receipt of multimodal treatment and survival.

Methods

The Texas Cancer Registry was used to identify patients diagnosed with stage IV CRC from 2004–2017. We identified those who received care at either: a National Cancer Institute-designated (NCI-D), an American College of Surgeons-Commission on Cancer-designated (ACS-D), or an undesignated facility. We used multivariable logistic regression and Cox regression for analysis to assess receipt of one or more treatment modality and 5-year overall survival.

Results

Of 19,355 patients with stage IV CRC, 2955 (15%) received care at an NCI-D facility and 5871 (30%) received multimodal therapy. Both NCI-D (odds ratio [OR] 1.64; 95% confidence interval [CI] 1.49–1.81) and ACS-D (OR 1.37; 95% CI 1.27–1.48) were associated with increased likelihood of multimodal therapy compared with undesignated centers. NCI-D also was associated with significantly improved survival (hazard ratio [HR] 0.74; 95% CI 0.70–0.78), although ACS-D was associated with a modest improvement in survival (HR 0.95; 95% CI 0.92–0.99). Receipt of multimodal therapy was strongly associated with improved survival (HR 0.61; 95% CI 0.59–0.63).

Conclusions

In patients with stage IV CRC, treatment at ACS-D and NCI-D facilities was associated with increased use of multimodality therapy and improved survival. However, only a small proportion of patients have access to these specialized centers, highlighting a need for expanded access to multimodal therapies at other centers.

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References

  1. Cancer Stat Facts: Colorectal Cancer. Accessed 10 March 2022. https://seer.cancer.gov/statfacts/html/colorect.html

  2. Key Statistics for Colorectal Cancer. Accessed 10 Oct 2020. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html

  3. Van Cutsem E, Cervantes A, Nordlinger B, Arnold D, Group EWG. Metastatic colorectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Suppl 3):iii1-9. https://doi.org/10.1093/annonc/mdu260.

    Article  PubMed  Google Scholar 

  4. Zhang GQ, Taylor JP, Stem M, et al. Aggressive multimodal treatment and metastatic colorectal cancer survival. J Am Coll Surg. 2020;230(4):689–98. https://doi.org/10.1016/j.jamcollsurg.2019.12.024.

    Article  PubMed  Google Scholar 

  5. NCI-Designated Cancer Centers. Accessed 10 March 2022. https://www.cancer.gov/research/infrastructure/cancer-centers

  6. Commission on Cancer. Accessed 10 March 2023. https://www.facs.org/quality-programs/cancer-programs/commission-on-cancer/

  7. Murimwa GZ, Karalis JD, Meier J, et al. Hospital designations and their impact on guideline-concordant care and survival in pancreatic cancer. Do they matter? Ann Surg Oncol. 2023. https://doi.org/10.1245/s10434-023-13308-7.

    Article  PubMed  Google Scholar 

  8. Texas Cancer Registry. Accessed 16 March 2023. https://www.dshs.texas.gov/texas-cancer-registry

  9. Ju MR, Karalis JD, Bhat A, et al. Nativity status is an important social determinant of health for hispanic patients with gastric cancer in Texas. Ann Surg Oncol. 2022;29(5):3113–21. https://doi.org/10.1245/s10434-021-11188-3.

    Article  PubMed  Google Scholar 

  10. Feo L, Polcino M, Nash GM. Resection of the primary tumor in stage IV colorectal cancer: When is it necessary? Surg Clin North Am. 2017;97(3):657–69. https://doi.org/10.1016/j.suc.2017.01.012.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Adam R, Vinet E. Regional treatment of metastasis: surgery of colorectal liver metastases. Ann Oncol. 2004;15(Suppl 4):iv103–6. https://doi.org/10.1093/annonc/mdh912.

    Article  PubMed  Google Scholar 

  12. Fong ZV, Chang DC, Hur C, et al. Variation in long-term oncologic outcomes by type of cancer center accreditation: an analysis of a SEER-Medicare population with pancreatic cancer. Am J Surg. 2020;220(1):29–34. https://doi.org/10.1016/j.amjsurg.2020.03.035.

    Article  PubMed  PubMed Central  ADS  Google Scholar 

  13. Huo YR, Phan K, Morris DL, Liauw W. Systematic review and a meta-analysis of hospital and surgeon volume/outcome relationships in colorectal cancer surgery. J Gastrointest Oncol. 2017;8(3):534–46. https://doi.org/10.21037/jgo.2017.01.25.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lam MB, Figueroa JF, Feyman Y, Reimold KE, Orav EJ, Jha AK. Association between patient outcomes and accreditation in US hospitals: observational study. BMJ. 2018;363:k4011. https://doi.org/10.1136/bmj.k4011.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Teh SH, Uong S, Lin TY, et al. Clinical outcomes following regionalization of gastric cancer care in a US integrated health care system. J Clin Oncol. 2021;39(30):3364–76. https://doi.org/10.1200/JCO.21.00480.

    Article  PubMed  Google Scholar 

  16. Latenstein AEJ, Mackay TM, van der Geest LGM, et al. Effect of centralization and regionalization of pancreatic surgery on resection rates and survival. Br J Surg. 2021;108(7):826–33. https://doi.org/10.1093/bjs/znaa146.

    Article  CAS  PubMed  Google Scholar 

  17. Resio BJ, Chiu AS, Hoag JR, et al. Motivators, barriers, and facilitators to traveling to the safest hospitals in the United States for complex cancer surgery. JAMA Netw Open. 2018;1(7):e184595. https://doi.org/10.1001/jamanetworkopen.2018.4595.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Finlayson SR, Birkmeyer JD, Tosteson AN, Nease RF Jr. Patient preferences for location of care: implications for regionalization. Med Care. 1999;37(2):204–9. https://doi.org/10.1097/00005650-199902000-00010.

    Article  CAS  PubMed  Google Scholar 

  19. Levine RA, Chawla B, Bergeron S, Wasvary H. Multidisciplinary management of colorectal cancer enhances access to multimodal therapy and compliance with National Comprehensive Cancer Network (NCCN) guidelines. Int J Colorectal Dis. 2012;27(11):1531–8. https://doi.org/10.1007/s00384-012-1501-z.

    Article  PubMed  Google Scholar 

  20. US States-Ranked by Population. 2023. https://worldpopulationreview.com/states

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Acknowledgment

The authors thank Dave Primm of the UT Southwestern Department of Surgery for help editing this article.

Funding

GM is supported by a Physician-Scientist Institutional Award from the Burroughs Wellcome Fund (Award No. 1018897) and an NCI/NIH supplement (Award No. 3R01CA243577-02S1). PP is supported by the Eugene P. Frenkel, M.D., Scholar Award at UT Southwestern.

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Authors and Affiliations

  1. Department of Surgery, University of Texas Southwestern, Dallas, TX, USA

    Jennie Meier MD, MPH, Gilbert Murimwa MD, Georgios Karagkounis MD, Adam Yopp MD, Herbert J. Zeh III MD & Patricio M. Polanco MD

  2. Department of Mathematics, University of Texas at Dallas, Dallas, TX, USA

    Mithin Nehrubabu BS

  3. Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, USA

    Lisa DiMartino PhD, MPH

  4. Division of Digestive & Liver Diseases, University of Texas Southwestern, Dallas, TX, USA

    Amit G. Singal MD

Authors
  1. Jennie Meier MD, MPH
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  2. Gilbert Murimwa MD
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  3. Mithin Nehrubabu BS
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  4. Lisa DiMartino PhD, MPH
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  5. Amit G. Singal MD
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  6. Georgios Karagkounis MD
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  7. Adam Yopp MD
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  8. Herbert J. Zeh III MD
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  9. Patricio M. Polanco MD
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Corresponding author

Correspondence to Patricio M. Polanco MD.

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Meier, J., Murimwa, G., Nehrubabu, M. et al. Effect of Hospital Cancer Designation on use of Multimodal Therapy and Survival of Metastatic Colorectal Cancer: A State-Wide Analysis. Ann Surg Oncol 31, 2591–2597 (2024). https://doi.org/10.1245/s10434-023-14859-5

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