2008 Annual Meeting Abstracts
Surgeons' Volume of Colorectal Cancer Procedures and Collaborative Decision-making about Adjuvant Therapies
selwyn O. rogers, Jr., md, mph1, John Z. Ayanian, MD, MPP1, Clifford Y. Ko, MD, MHHS2, Katherine L. Kahn, MD2, Alan M. Zaslavsky, PhD3, Robert S. Sandler, MD4, Nancy L. Keating, MD, MPH1.
1brigham and women's hospital, boston, MA, USA, 2UCLA, LA, CA, USA, 3Harvard Medical School, boston, MA, USA, 4University of North Carolina, Chapel Hill, CA, USA.
Objective: Few data are available to assess why procedures performed by higher-volume surgeons are associated with better outcomes. This study was designed to understand the relationship of surgical volume to collaboration with other physicians for surgeons caring for patients with colorectal cancer (CRC) in decisions about adjuvant chemotherapy and radiation therapy.
Design: Mailed survey to surgeons caring for patients with CRC.
Setting: Across multiple regions and health systems in the United States, surgeons responded to a mailed survey.
Patients: Patients with newly diagnosed CRC.
Main Outcome Measures: We used Chi square tests and multivariable logistic regression to assess physician and practice characteristics associated with surgical volume. We then used logistic regression to assess the association of surgical volume with collaborative decision-making regarding adjuvant chemotherapy and radiation therapy, controlling for other characteristics.
Results: Of 635 responding surgeons, those who practiced in single or multi-specialty groups or hospital based practices (vs. solo), practice at comprehensive cancer centers, participate in teaching, and attend weekly tumor board meetings were more likely to be high-volume CRC surgeons (all p<0.05). Most surgeons reported collaborated with other physicians in decisions about adjuvant chemotherapy (61%) and radiation therapy (65%) for their patients with CRC. Higher volume surgeons more often reported a collaborative role with other physicians in decisions about chemotherapy (p<0.001) and radiation therapy (p<0.001), controlling for other characteristics.
Conclusions: Higher volume surgeons are more likely to collaborate with other physicians in decisions about adjuvant therapies for patients following CRC resection. These collaborative relationships of higher-volume surgeons may contribute to their patient's improved outcomes.