Does geography influence the treatment and outcomes of colorectal cancer? A population-based analysis

Abstract

BackgroundThe Canadian province of Manitoba covers a large geographical area but only has one major urban center, Winnipeg. We sought to determine if regional differences existed in the quality of colorectal cancer care in a publicly funded health care system.MethodsThis was a population-based historical cohort analysis of the treatment and outcomes of Manitobans diagnosed with colorectal cancer between 2004 and 2006. Administrative databases were utilized to assess quality of care using published quality indicators.ResultsA total of 2,086 patients were diagnosed with stage I to IV colorectal cancer and 42.2% lived outside of Winnipeg. Patients from North Manitoba had a lower odds of undergoing major surgery after controlling for other confounders (odds ratio (OR): 0.48, 95% confidence interval (CI): 0.26 to 0.90). No geographic differences existed in the quality measures of 30-day operative mortality, consultations with oncologists, surveillance colonoscopy, and 5-year survival. However, there was a trend towards lower survival in North Manitoba.ConclusionWe found minimal differences by geography. However, overall compliance with quality measures is low and there are concerning trends in North Manitoba. This study is one of the few to evaluate population-based benchmarks for colorectal cancer therapy in Canada.

Short‐term outcomes after surgical resection for colorectal cancer in South Australia

“…Advanced stage, older age, emergency admission and comorbidity increased the risk of postoperative deaths following resection for CRC. Thirty‐day postoperative mortality was also higher among non‐metropolitan than metropolitan residents, which contrasts with the findings of Jorgensen et al (Australia) and Helewa et al (Canada) who found no regional disparities in 30‐day mortality, after case‐mix adjustment. International studies suggest higher volume hospitals are better placed to manage complications during surgery .…”

Geographical differences in upper abdominal resectional surgery and high-volume procedures in Sweden during 2009–2011

“…This leads to true population-based data, irrespective of referral patterns or number of operating centers, which change over time. Investigation of geographical differences in surgical care is often based on a specific diagnosis [5][6][7][8]. To our knowledge, this issue has not been elucidated from the wider professional standpoint of upper abdominal surgery in a population-based setting.…”

Counties eliminating racial disparities in colorectal cancer mortality

“…80 Higher uninsured rates at the county level are associated with higher rates of late-stage diagnosis and mortality, and a lower likelihood of being recommended for cancer surgery. 81 A secret shopper survey of gastroenterologists in Connecticut demonstrated that only a small number of gastroenterology practices actually accepted Medicaid patients. 82 Although hospitals in California serving a high-volume of patients with CRC were found to have lower CRC death rates, minority patients were significantly less likely to use these high-volume hospitals despite a higher likelihood of living nearby.…”