Policies favoring high-volume hospitals may disadvantage rural cancer patients

Sufferers with most cancers who reside in rural Pennsylvania counties seem to know that they might have higher outcomes in the event that they obtain their most cancers surgical procedure at a hospital that performs a excessive quantity of these surgical procedures, however nonetheless go for decrease quantity hospitals nearer to house when their most cancers is probably going much less complicated, in accordance with a brand new evaluation revealed at this time in JCO Oncology Apply by well being coverage scientists on the College of Pittsburgh Faculty of Public Well being.

With a scarcity of skilled surgeons in rural America and rural hospital closures, offering acceptable surgical care to rural sufferers might be difficult. Applications and insurance policies intention to centralize most cancers providers by steering surgical patients to high-volume hospitals, that are largely situated in urban areas.

These insurance policies have the potential to tie insurance coverage reimbursements to high quality metrics that embrace surgical quantity. Nevertheless, the examine findings point out it could be obligatory to include further measures—such because the complexity and severity of the most cancers, in addition to affected person high quality of life and satisfaction—when setting insurance policies that dictate the place sufferers can and can’t obtain cancer care. Doing so might encourage hospitals to proceed providing such surgical procedures nearer to house for rural sufferers when attainable.

“Our examine means that narrowly specializing in hospital volumes and tying that to insurance coverage reimbursement would possibly masks complexities and trade-offs in reaching the aim of optimizing affected person outcomes and experiences,” mentioned senior writer Lindsay Sabik, Ph.D., affiliate professor in Pitt Public Well being’s Division of Well being Coverage and Administration. “Not solely are there value and time burdens for rural sufferers who should journey for care, however they’re away from their native assist networks, which may influence their high quality of life.”

Sabik and lead writer Haleh Ramian, Ph.D., who carried out the examine whereas a postdoctoral researcher at Pitt Public Well being, obtained statewide knowledge from the Pennsylvania Well being Care Value Containment Council on adult patients with a analysis of lung, pancreas, breast, mind, rectum, bladder, colon, esophagus, prostate or abdomen most cancers who underwent surgical procedure between 2017 by way of 2020. They established whether or not every affected person lived in one of many state’s 19 city counties or 48 rural counties.

They then decided whether or not every of Pennsylvania’s 156 hospitals could possibly be categorised as “high-volume” relying on whether or not they fell into the highest 10% to 30% for the variety of surgical procedures carried out for any given most cancers sort.

Rural sufferers with pancreatic or esophageal cancers—which generally require complicated surgical procedures—had been extra doubtless than sufferers who reside in city counties to obtain that surgical procedure at a high-volume hospital. For mind and stomach cancerthe charges had been practically comparable between rural and concrete sufferers.

However for a lot of the different most cancers varieties, which can entail much less complicated surgical procedure, rural sufferers had been much less doubtless than their city counterparts to obtain cancer surgery at hospitals that carry out a excessive quantity of these surgical procedures, regardless that analysis reveals that hospital quantity is related to improved outcomes.

As a result of high-volume hospitals usually tend to be situated in metropolitan areas, it was not stunning to the researchers that sufferers dwelling in rural areas had been much less prone to have their most cancers surgical procedures at them than sufferers dwelling in city areas. However the truth that rural sufferers had been touring to high-volume hospitals for extra complicated most cancers surgical procedures was telling.

“To us, this means that sufferers are conscious that they’re extra prone to have higher outcomes at high-volume hospitals and they’re searching for out these hospitals when their most cancers is extra complicated,” mentioned Ramian. “However when their most cancers surgical procedure is probably going easier, they’re weighing the dangers with the comfort and assist they’ve when receiving their surgical procedure nearer to house at a hospital that performs the surgical procedure much less typically.”

The researchers confused that their examine had a number of limitations, together with that it couldn’t account for most cancers sufferers who could have chosen to not have surgical procedure; solely checked out hospital quantity, not surgeon quantity; and couldn’t decide whether or not sufferers made completely different selections about the place to get most cancers surgical procedure relying on the severity, or stage, of their most cancers.

“Future analysis ought to transfer past focusing totally on the centralization of most cancers surgical procedure to enhance outcomes and take into account the implications of centralization on high quality of life and the continuum of most cancers care together with surgical procedure in addition to chemotherapy and radiation,” mentioned Sabik, additionally director of the workgroup on most cancers well being providers analysis at Pitt’s Well being Coverage Institute. “Figuring out and executing methods that might assist make most cancers surgery extra equitable for underserved populations might counter disparities in most cancers look after all.”