Hospital Surgical Volume And Concordance With Adjuvant Chemotherapy Guidelines In Older Adults With Cancer

Purpose: High-volume cancer centers have repeatedly been shown to have improved survival when compared to low volume centers, and, unfortunately, a high proportion of cancer patients eligible for post-operative chemotherapy following surgical resection of non-metastatic solid tumors never receive this therapy, even though it provides a survival benefit. We hypothesized that patients who received their surgical resection at high-volume cancer centers would be more likely to receive indicated adjuvant chemotherapy than patients who received their surgical resection at low volume centers. Methods: We identified gastric, non-small cell lung, and colon cancer patients in SEER-Medicare between 2004-2012 where their final pathological staging resulted in an NCCN recommendation to receive adjuvant chemotherapy. Patients who received neoadjuvant chemotherapy were excluded, as were patients with metastatic disease at the time of diagnosis, and we investigated the impact of hospital volume on the likelihood that a patient would have a post-discharge consultation with a medical oncologist or receive adjuvant chemotherapy. Results: Patients with non-small cell lung and colon cancer who received their surgical resection at a high-volume institution were more likely (p < 0.05) to have a post-discharge consultation with a medical oncologist, though these differences disappeared when important patient-level characteristics were adjusted for. There were no differences in the rates of receiving adjuvant chemotherapy by surgical volume, yet increasing surgical volume was associated with improved disease specific survival (p < 0.03 for each disease). Discussion: Use of adjuvant chemotherapy is sub-optimal for elderly patients with gastric, non-small cell lung, and colon cancer, but is not affected by the surgical volume of their operative hospital. Survival differences between high- and low-volume hospitals cannot be explained by differences in use of adjuvant chemotherapy. Further work is needed to identify, and correct, the reasons for sub-optimal administration of adjuvant chemotherapy in eligible patients