Sunil V. Patel , Tyler McKechnie , Chad McClintock , Weidong Kong , Clare Bankhead , Christopher M. Booth , Carl Heneghan , Ameer Farooq
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The primary exposure was Cancer Centre Level Designation as defined by Cancer Care Ontario (i.e., Level 1/2 = regional cancer center; Level 3 = affiliate cancer center; Level 4 = satellite cancer center). The primary outcomes were guideline adherent care and survival. Associations were determined using one-way analysis of variances and a multivariable Cox proportional hazards model.</div></div><div><h3>Results</h3><div>12,399 patients were included with 54 % from a Level 1/2 centre, 33 % from a Level 3 centre and 13 % from a Level 4+ centre. All assessed aspects of guideline adherent care were associated with cancer centre level designation. Unadjusted 5-year overall survival was associated with cancer centre level designation (Level 1/2 79.5 % vs. Level 3 79.1 % vs. Level 4/non-designated 75.4 %, P = 0.003). Adjusted Cox Proportional Hazard Analysis for overall survival found the following: Level 4/5 HR 1.11 (95 %CI 0.99 – 1.25); Level 3 HR 1.01 (95 % CI 0.93 – 1.11); Level 1/2 1 [Referent group].</div></div><div><h3>Conclusions</h3><div>Increasing Cancer Centre Level Designation was associated with higher likelihood of receiving the appropriate investigations and treatments in those with rectal cancer and may also be associated with survival.</div></div><div><h3>Policy Summary</h3><div>Future work should consider the centralization of complex rectal cancer care as well as quality improvement initiatives aimed at enhancing guideline adherent care across all centres managing rectal cancer.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100510"},"PeriodicalIF":2.0000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"An assessment of cancer centre level designation and guideline adherent care in those with rectal cancer: A population based retrospective cohort study\",\"authors\":\"Sunil V. 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引用次数: 0
摘要
背景：为癌症患者提供护理的机构是根据可用资源和所提供的治疗方法来组织的。据推测，护理级别的提高将导致护理质量和效果的改善。本研究的目的是确定癌症级别指定是否与遵循指南的护理和/或生存有关：这是一项对安大略省直肠癌队列（Ontario Rectal Cancer Cohort）中的个体进行的回顾性研究，该队列是一个人口级数据库，包括加拿大安大略省在 2010 - 2019 年间接受直肠癌手术切除的所有成年人。主要暴露指标是安大略省癌症护理中心（Cancer Care Ontario）定义的癌症中心级别（即1/2级=区域癌症中心；3级=附属癌症中心；4级=卫星癌症中心）。主要结果是遵循指南的护理和存活率。采用单因素方差分析和多变量考克斯比例危险模型确定相关性：共纳入12399名患者，其中54%来自1/2级中心，33%来自3级中心，13%来自4+级中心。所有接受评估的指南依从性护理都与癌症中心的级别有关。未经调整的5年总生存率与癌症中心的级别指定有关（1/2级79.5% vs. 3级79.1% vs. 4级/非指定75.4%，P = 0.003）。调整后的总生存率Cox比例危险分析结果如下：4/5 级 HR 1.11 (95%CI 0.99 - 1.25)；3 级 HR 1.01 (95%CI 0.93 - 1.11)；1/2 级 1 [参照组]：癌症中心等级的提高与直肠癌患者接受适当检查和治疗的可能性增加有关，也可能与生存率有关。政策摘要：今后的工作应考虑将复杂的直肠癌治疗集中起来，并采取质量改进措施，以提高所有直肠癌治疗中心遵守指南的治疗水平。
An assessment of cancer centre level designation and guideline adherent care in those with rectal cancer: A population based retrospective cohort study
Background
Institutions providing care to individuals with cancer are organized based on available resources and treatments offered. It is presumed that increasing levels of care will result in improved quality of care and outcomes. The objective is to determine whether Cancer Level Designation is associated with guideline adherent care and/or survival.
Methods
This is a retrospective study of individuals within the Ontario Rectal Cancer Cohort, a population-level database including all adults undergoing surgical resection for rectal cancer between 2010 – 2019 were included in Ontario, Canada. The primary exposure was Cancer Centre Level Designation as defined by Cancer Care Ontario (i.e., Level 1/2 = regional cancer center; Level 3 = affiliate cancer center; Level 4 = satellite cancer center). The primary outcomes were guideline adherent care and survival. Associations were determined using one-way analysis of variances and a multivariable Cox proportional hazards model.
Results
12,399 patients were included with 54 % from a Level 1/2 centre, 33 % from a Level 3 centre and 13 % from a Level 4+ centre. All assessed aspects of guideline adherent care were associated with cancer centre level designation. Unadjusted 5-year overall survival was associated with cancer centre level designation (Level 1/2 79.5 % vs. Level 3 79.1 % vs. Level 4/non-designated 75.4 %, P = 0.003). Adjusted Cox Proportional Hazard Analysis for overall survival found the following: Level 4/5 HR 1.11 (95 %CI 0.99 – 1.25); Level 3 HR 1.01 (95 % CI 0.93 – 1.11); Level 1/2 1 [Referent group].
Conclusions
Increasing Cancer Centre Level Designation was associated with higher likelihood of receiving the appropriate investigations and treatments in those with rectal cancer and may also be associated with survival.
Policy Summary
Future work should consider the centralization of complex rectal cancer care as well as quality improvement initiatives aimed at enhancing guideline adherent care across all centres managing rectal cancer.
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