Collaboration Between Surgeons and Medical Oncologists Improves Outcomes for Patients With Stage III Colon Cancer

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Collaboration between surgeons and medical oncologists “is associated with lower mortality without increased cost among patients with stage III colon cancer,” according to a study by Tanvir ­Hussain, MD, MSc, and colleagues from Johns Hopkins University School of Medicine, Baltimore, and the University of Michigan Health System, Ann Arbor.

“We operationalized collaboration between surgeons and oncologists as the number of patients they shared (ie, when both providers bill for medical services for the same patient), because this has been shown to reflect advice seeking and referral relationships between physicians,” the authors ­explained.

Survival Benefit

An increase from one to five in the number of patients receiving shared care from a surgeon and medical oncologist “translated into an approximately 20% improved survival benefit from all-cause and colon cancer–specific mortalities,” the researchers reported the Journal of ­Oncology ­Practice.

Coordination of cancer care has been identified as a “priority area for improvement” by the National Institutes of Medicine, the investigators noted. Explaining their focus on stage III colon cancer, they wrote: “Stage III colon cancer requires timely surgery and adjuvant chemotherapy to improve survival. Because this involves coordination between specialists, patients with stage III colon cancer are vulnerable to poor coordination; many patients do not receive guideline-concordant care, and disparities exist.”

Study Details

The retrospective cohort study looked at patients with stage III colon cancer identified using Surveillance, Epidemiology, and End Results (SEER)-Medicare data and diagnosed between 2000 and 2009. All patients were over age 65, slightly more than 57% were female, and close to 86% were white. Overall, 5,160 patients (55.3%) died during the 12-year observation period, which extended until December 31, 2011. The median survival time was 5.3 years.

“A total of 9,329 patients received care from 3,623 different surgeons and 2,319 medical oncologists, representing 6,827 unique surgeon–medical oncologist pairs,” the investigators found. The median number of shared patients was three.

“As the number of patients shared between specialists increased from one to five (25th to 75th percentile), patients experienced an approximately 20% improved survival benefit from all-cause and colon cancer–specific mortalities. Specifically, for each additional patient shared between oncologist and surgeon, all-cause mortality improved by 5% (hazard ratio = 0.95; 95% confidence interval [CI], 0.92–0.97), and colon cancer–specific mortality improved by 5% (subhazard ratio = 0.95; 95% CI, 0.91–0.97),” the researchers reported. They found no association between collaboration and cost of care.

“Even after accounting for whether specialists worked in the same or different hospitals, patient sharing remained associated with lower mortality, which may suggest that additional informal mechanisms are important,” the investigators pointed out.

“Facilitating formal and informal collaboration between specialists may be an important strategy for improving the care of patients with complex ­cancers,” they concluded. ■

Hussain T, et al: J Oncol Pract 11:e388-e397, 2015.