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Use of adjuvant radiotherapy at hospitals with and without on-site radiation services†
Article first published online: 8 JAN 2007
Copyright © 2007 American Cancer Society
Volume 109, Issue 4, pages 796–801, 15 February 2007
How to Cite
Wong, S. L., Wei, Y. and Birkmeyer, J. D. (2007), Use of adjuvant radiotherapy at hospitals with and without on-site radiation services. Cancer, 109: 796–801. doi: 10.1002/cncr.22458
The views expressed herein do not necessarily represent the views of the Center for Medicare and Medicaid Services or the United States Government.
- Issue published online: 2 FEB 2007
- Article first published online: 8 JAN 2007
- Manuscript Accepted: 17 NOV 2006
- Manuscript Revised: 20 OCT 2006
- Manuscript Received: 30 AUG 2006
- National Cancer Institute. Grant Number: R01 CA098481-01A1
- radiation therapy;
- supply-sensitive care;
- pancreatic cancer;
- rectal cancer
In many areas of health care, whether patients receive specific medical interventions often is influenced heavily by the local availability of resources for delivering those services. However, relations between resource availability and utilization are relatively unexplored in cancer care, including perioperative adjuvant therapy.
The authors studied associations between the on-site availability of radiation services and the use of adjuvant radiotherapy using the national, linked Surveillance, Epidemiology, and End Results-Medicare database (from 1992 to 2002). They examined 1 cancer for which the effectiveness of adjuvant radiotherapy was well established in randomized clinical trials (rectal cancer) and another cancer for which it was not (pancreatic cancer) (N = 10,198). The availability of on-site radiation services at the hospital where surgery was performed was assessed by using data from the American Hospital Association. In comparing rates of adjuvant radiotherapy, analyses were adjusted for both patient characteristics and other hospital attributes.
For rectal cancer, the use of adjuvant radiotherapy was similar in patients who underwent surgery at centers with and without on-site radiation services (29% vs 29%, respectively). Among patients with pancreatic cancer, however, those who underwent surgery at hospitals with on-site radiation services were twice as likely to receive radiotherapy than patients who underwent surgery at hospitals without such services (43% vs 26%, respectively; adjusted odds ratio, 2.1; 95% confidence interval, 1.4–3.2). Adjusting for other factors, the groups had similar survival rates for each cancer.
The availability of on-site radiation services significantly increased the likelihood that patients would receive radiotherapy, at least for cancers for which the effectiveness of such therapy was not well established. Cancer 2007. © 2007 American Cancer Society.