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

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Key Points

  • Collaboration between surgeons and medical oncologists was associated with lower mortality in patients with stage III colon cancer.
  • An increase from one to five in the number of patients receiving coordinated care from a surgeon and a medical oncologist resulted in an approximately 20% improved survival benefit from all-cause and colon cancer–specific mortalities.
  • Cost did not increase with collaborative care.

Collaboration between surgeons and medical oncologists specialists “is associated with lower mortality without increased cost among patients with stage III colon cancer,” according to a study by Hussain et al in the Journal of Oncology Practice. An increase from one to five in the number of patients receiving coordinated care from a surgeon and a medical oncologist “translated into an approximately 20% improved survival benefit from all-cause and colon cancer–specific mortalities,” the researchers reported.

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, the researchers 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.”

Shared Patients Reflect Advice Seeking

The retrospective cohort study looked at patients with stage III colon cancer identified using SEER-Medicare data from 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.

“We operationalized collaboration between surgeons and oncologists as the number of patients 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.

“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.

Formal and Informal Mechanisms

“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.” 

Tanvir Hussain, MD, MSc, of Johns Hopkins University School of Medicine, is the corresponding author of the Journal of Oncology Practice article.

The study was supported by grants from the National Cancer Institute, the Maryland Cigarette Restitution Fund, and the National Heart, Lung, and Blood Institute.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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