Association between the availability of medical oncologists and initiation of chemotherapy for patients with stage III colon cancer

• Type of Material: Article
• Authors: Chun Chieh Anna Lin, American Cancer Society; Katherine Virgo, Emory University
• Language: English
• Date: 2013-01-01
• Publisher: American Society of Clinical Oncology
• Publication Version: Final Published Version
• Copyright Statement: Copyright © 2013 American Society of Clinical Oncology. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1200/JOP.2012.000627
• Title of Journal or Parent Work: Journal of Oncology Practice
• Volume: 9
• Issue: 1
• Start Page: 27
• End Page: 33
• Grant/Funding Information: Supported by American Cancer Society Intramural Research Funding. Presented in part at the 33rd Annual Meeting of the Society of Medical Decision Making, October 22-26, 2011, Chicago, IL.
• Keywords: Female; Hospitals; Workforce; United States; Aged; Male; Colonic Neoplasms; Colectomy; Aged, 80 and over; Neoplasm Staging; Humans; Medical Oncology; Medicare
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Oncology

Abstract

Purpose: Although the number of medical oncologists (MOs) has steadily increased over time, and adjuvant chemotherapy provides significant survival benefit for patients with stage III colon cancer, many patients still do not receive chemotherapy. Uneven geographic distribution of MOs may contribute to decreasing access to cancer care. This study explored the association of MO availability by hospital service area (HSA) of patient residence and access to chemotherapy treatment. Methods: Using the linked SEER-Medicare database, the study identified 9,262 patients who were age ≥66 years and underwent colectomy for stage III colon cancer diagnosed from 2000 to 2005. MOs were identified by physician specialty codes. HSAs are geographic areas that are relatively self-contained with respect to routine hospital care. Multivariate logistic regression was used to investigate the association between MO availability by HSA of patient residence and initiation of chemotherapy. Results: Within 3 months after colectomy, 5,622 patients (60.7%) initiated chemotherapy. Adjusting for clinical and patient characteristics, patients residing in an HSA with ≥ one MO had an increased likelihood of initiating chemotherapy within 3 months after colectomy compared with those living in areas with no MOs (one to two MOs: OR, 1.451 [P <.01]; three to eight MOs: OR, 1.497 [P <.01]; ≥ nine MOs: OR, 1.322 [P <.01]). Conclusion: Results suggest that the availability of ≥ one MO within the HSA in which a patient resides was associated with greater access to chemotherapy after surgery.