Geographic variation in follow-up after rectal cancer surgery

Abstract

Abstract. Most patients with rectal cancer are treated with curative-intent surgery; adjuvant chemotherapy and radiation are often used as well. A recent survey of members of the American Society of Colon and Rectal Surgeons (ASCRS) revealed considerable variation in surveillance intensity after primary treatment. We evaluated whether geographic factors may be responsible for the observed variation. Vignettes of hypothetical patients and a questionnaire based on the vignettes were mailed to the 1782 members of ASCRS. Repeated-measures analysis of variance was used to compare practice patterns, as revealed by the responses, according to US Census Regions and Divisions, Metropolitan Statistical Areas (MSA), and state-specific managed care organization (MCO) penetration rates. There was significant variation in surveillance intensity according to the US Census Region and Division in which the surgeon practiced. Non-US respondents employed CT of the abdomen and pelvis, chest radiography, and colonoscopy significantly more often than US respondents. MSA was not a significant source of variation. Surveillance patterns varied significantly by MCO penetration rate for office visits and CT of the abdomen and pelvis but not for other modalities. The US Census Region and Division in which the surgeon practices have a significant effect on surveillance intensity following completion of primary curative-intent therapy for rectal cancer patients. The MSA in which the surgeon practices does not affect surveillance intensity significantly and MCO penetration rate affects follow-up intensity minimally. All significant differences are clinically rather modest, however. These data should be useful in the design of controlled trials on this topic.

A comparison of direct medical costs across racial and ethnic groups among children with cancer

“…The significant effects of these measures on health services utilization have also been documented 25,26 . The significant effects of the census regions may be due to different practices of medicine across geographic regions 28,29 .…”

Many Patients Who Undergo Surgery for Colorectal Cancer Receive Surveillance Colonoscopies Earlier Than Recommended by Guidelines

“…The regional variation is likely related to variation in practice patterns and health care delivery systems. 16, 31, 32 …”

Diagnosis delay and follow-up strategies in colorectal cancer. Prognosis implications: a study protocol

“…Endoscopic techniques are the most frequently used, and imaging methods are the least used, with considerable variability amongst the different experts consulted [ 23 ]. Variability also exists depending on the geographic location of the experts consulted [ 37 ]. Other authors indicate that surveillance after potentially curative colon cancer surgery is not significantly affected by the geographic location of the surgeon who performs the surveillance testing, and only modestly affected by the population size of the metropolitan area in which he/she practices [ 31 ].…”