Outcomes/Effectiveness Research

Surgeon's experience and patient demographics influence the treatment and outcomes of colorectal cancer

Aside from the stage of their tumors, the treatment provided to patients with colorectal cancer and how they fare depend in large part on how many cancer surgeries of this type their surgeons have done. The number of colonoscopies done at the patient's hospital and the patient's race and socioeconomic status also influence treatment and outcomes. In fact, these factors sometimes make the difference between whether a patient must undergo permanent colostomy (creation of an opening leading from the colon to the skin surface) or not, according to a study supported by the Agency for Healthcare Research and Quality (HS09869).

John Z. Ayanian, M.D., of Harvard Medical School, and his colleagues reviewed studies from 1980 to 2000 that examined the impact of physician, hospital, and patient factors (including insurance type) on treatment and outcomes of patients with colorectal cancer. Their analysis revealed that greater surgeon experience and case volume were associated with improved tumor control, although surgeon and hospital factors were not consistently associated with postoperative mortality or long-term survival. There also was no evidence that patients treated by HMO providers received substantially different treatment or had different outcomes than those who received care under traditional fee-for-service plans. Some studies indicated that patients were less likely to undergo permanent colostomy—meaning the surgeon was able to preserve their sphincter muscle—if they were treated by surgeons and hospitals that did a high volume of surgeries for colorectal cancer.

Certain patient characteristics influenced cancer treatment. Older patients were less likely to be given chemotherapy after surgery than younger patients, even after adjustment for other coexisting illnesses and tumor stage. Black and American Indian patients with colorectal cancer received less intensive therapy and had worse outcomes than white patients. When black and white patients did receive comparable care, the two groups had similar rates of survival, indicating that racial disparities in treatment may account in part for the disparities in outcome.

See "Impact of patient and provider characteristics on the treatment and outcomes of colorectal cancer," by David C. Hodgson, Charles S. Fuchs, and Dr. Ayanian, in the April 4, 2001 Journal of the National Cancer Institute 93(7), pp. 501-515.

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