Does Fragmentation of Care in Locally Advanced Rectal Cancer Increase Patient Mortality?

Area of Science:

• Oncology
• Health Services Research
• Cancer Care Delivery

Background:

• Fragmentation of care, defined as receiving treatment across multiple hospitals, may negatively impact cancer patient outcomes.
• Understanding the effects of care fragmentation is crucial for improving treatment strategies in rectal cancer.

Purpose of the Study:

• To evaluate the impact of health care fragmentation on survival outcomes in patients diagnosed with stage II and III rectal cancer.
• To compare outcomes between integrated and fragmented care models in rectal cancer treatment.

Main Methods:

• The National Cancer Database was analyzed for adult patients with stage II-III rectal adenocarcinoma treated between 2006 and 2015.
• Fragmented care was identified as receiving radiation therapy at a different hospital than surgery.
• Survival probabilities were assessed using Kaplan-Meier and Cox proportional hazards models.

Main Results:

• A total of 37,081 patients were included, with 12,979 receiving fragmented care.
• Fragmented care was associated with a higher risk of mortality (HR 1.105).
• Integrated care, particularly at academic hospitals, was linked to improved survival outcomes.

Conclusions:

• Integrated care at academic hospitals is associated with better survival for stage II-III rectal cancer patients.
• Efforts to reduce care fragmentation and prioritize surgery at academic centers are recommended.
• Fragmented care at academic centers still showed improved survival compared to integrated care at community hospitals.