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The role of the surgeon in whether patients with lymph node-positive colon cancer see a medical oncologist†
Article first published online: 30 JAN 2007
Copyright © 2007 American Cancer Society
Volume 109, Issue 5, pages 975–982, 1 March 2007
How to Cite
Luo, R., Giordano, S. H., Zhang, D. D., Freeman, J. and Goodwin, J. S. (2007), The role of the surgeon in whether patients with lymph node-positive colon cancer see a medical oncologist. Cancer, 109: 975–982. doi: 10.1002/cncr.22462
The interpretation and reporting of the data are the sole responsibility of the authors.
- Issue published online: 22 FEB 2007
- Article first published online: 30 JAN 2007
- Manuscript Accepted: 20 NOV 2006
- Manuscript Revised: 15 NOV 2006
- Manuscript Received: 21 AUG 2006
- University of Texas Medical Branch Center for Population Health and Health Disparities. Grant Number: P50 CA10563
- National Cancer Institute. Grant Number: CA 104949
- Agency for Healthcare Research and Quality. Grant Number: R24 HS011618
- Applied Research Program, National Cancer Institute; to the Office of Research, Development, and Information, Centers for Medicare and Medicaid Services; to Information Management Services; and to the Surveillance, Epidemiology, and End Results (SEER) Program for the creation of the SEER-Medicare database
- colon cancer;
- adjuvant chemotherapy;
- medical oncology;
- referral and consultation;
- oncology service;
- teaching hospitals;
- End Results Program
Chemotherapy improves survival for patients with stage III colon cancer, but some older patients with lymph node-positive colon cancer do not see a medical oncologist and, thus, do not receive adjuvant chemotherapy.
To evaluate the role of the surgeon in determining referrals to medical oncology among patients with stage III colon cancer, the authors conducted a retrospective cohort study of 6158 patients aged ≥66 years who were diagnosed with stage III colon cancer from 1992 through 1999 by using the Surveillance, Epidemiology, and End Results-Medicare linked database. Multilevel analysis was used to simultaneously model variations in patients' seeing a medical oncologist at the patient and surgeon levels.
Twenty-one percent of the total variance in seeing a medical oncologist was attributable to the surgeon after adjusting for available patient, tumor, and surgeon characteristics. The individual surgeon characteristics that significantly predicted whether the patient saw a medical oncologist were year since graduation (≤10 years vs >20 years; hazard ratio [HR], 1.60; 95% confidence interval [95% CI], 1.19–2.16), practicing in a teaching hospital (yes vs. no: HR; 1.30; 95% CI, 1.07–1.58), and volume of patients with colon cancer (<30 patients vs ≥121 patients; HR, 0.66; 95% CI, 0.46–0.94). Surgeon sex, race, board certification, and type of practice were not independent predictors of medical oncology referral.
Surgeons accounted for approximately 20% of the variation in patients seeing a medical oncologist. Interventions at the level of the surgeon may be appropriate to improve the care of patients with colon cancer. Cancer 2007 © 2007 American Cancer Society.