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Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer.

Publication ,  Journal Article
Rhodin, KE; Raman, V; Eckhoff, A; Liu, A; Creasy, J; Nussbaum, DP; Blazer, DG
Published in: Ann Surg Oncol
September 2022

BACKGROUND: Optimal management of stage II/III gastric cancer requires multidisciplinary care, often necessitating treatment at more than one facility. We aimed to determine patterns of "fragmented" care and its impact on outcomes, including concordance with National Comprehensive Cancer Network (NCCN) guidelines and overall survival. METHODS: The 2006-2016 National Cancer Database was queried for patients with clinical stage II/III gastric adenocarcinoma who received preoperative therapy in addition to surgery. Patients were stratified based on whether surgery and chemotherapy/chemoradiation were performed at one versus multiple facilities (termed "coordinated" and "fragmented" care, respectively). Multivariable logistic regression was performed to identify factors associated with fragmented care. Survival was compared using Kaplan-Meier and Cox proportional hazards methods. RESULTS: Overall, 2033 patients met study criteria: 1043 (51.3%) received coordinated care and 990 (48.7%) fragmented care. There was no significant difference in time to surgery or pathologic upstaging by care structure. On adjusted analysis, factors associated with receipt of fragmented care included increasing age and distance traveled to the treating facility. Factors associated with coordinated care included metropolitan residence and treatment at academic and high-volume centers. Fragmented care was associated with a reduction in guideline-preferred perioperative chemotherapy (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.63-0.97, p = 0.02) and increased mortality (HR 1.16, 95% CI 1.00-1.34, p = 0.05). CONCLUSIONS: For patients with stage II/III gastric cancer, fragmented care is associated with inferior outcomes, including a reduction in preferred perioperative treatment and survival. Further work is needed to ensure equitable outcomes among patients as complex cancer care becomes more regionalized.

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Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

September 2022

Volume

29

Issue

9

Start / End Page

5422 / 5431

Location

United States

Related Subject Headings

  • Testicular Neoplasms
  • Stomach Neoplasms
  • Retrospective Studies
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Male
  • Humans
  • Chemoradiotherapy
 

Citation

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Rhodin, K. E., Raman, V., Eckhoff, A., Liu, A., Creasy, J., Nussbaum, D. P., & Blazer, D. G. (2022). Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer. Ann Surg Oncol, 29(9), 5422–5431. https://doi.org/10.1245/s10434-022-12031-z
Rhodin, Kristen E., Vignesh Raman, Austin Eckhoff, Annie Liu, John Creasy, Daniel P. Nussbaum, and Dan G. Blazer. “Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer.Ann Surg Oncol 29, no. 9 (September 2022): 5422–31. https://doi.org/10.1245/s10434-022-12031-z.
Rhodin KE, Raman V, Eckhoff A, Liu A, Creasy J, Nussbaum DP, et al. Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer. Ann Surg Oncol. 2022 Sep;29(9):5422–31.
Rhodin, Kristen E., et al. “Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer.Ann Surg Oncol, vol. 29, no. 9, Sept. 2022, pp. 5422–31. Pubmed, doi:10.1245/s10434-022-12031-z.
Rhodin KE, Raman V, Eckhoff A, Liu A, Creasy J, Nussbaum DP, Blazer DG. Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer. Ann Surg Oncol. 2022 Sep;29(9):5422–5431.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

September 2022

Volume

29

Issue

9

Start / End Page

5422 / 5431

Location

United States

Related Subject Headings

  • Testicular Neoplasms
  • Stomach Neoplasms
  • Retrospective Studies
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Male
  • Humans
  • Chemoradiotherapy