Association of quality and technology with patient mobility for colorectal cancer surgery

1. Around 30% of colorectal patients travel beyond their closest hospital site to undergo a primary bowel resection.

2. For rectal cancer patients, travelling to a more distant hospital site was associated with hospital factors, including presence of specialist colorectal cancer expertise and availability of robotic surgery, but not associated with patient mortality outcomes.

Evidence Rating Level: 2 (Good)

In some countries, patients are able to select which hospital they would like to receive an elective surgery in. Past studies have shown that hospital reputation and availability of robotic surgery are factors associated with individuals travelling farther than their closest health facility to seek out treatment. However, this practice could allow for inequities in the healthcare system, as patients who are younger patients and wealthier are more likely to travel to these centres. As well, it is also unclear if patient outcomes at these centres are factored into individual’s decisions to seek surgery at a location farther away from home. Therefore, this choice modeling study examined the travel patterns and hospital characteristics for patients seeking care for colorectal cancer in the UK. This study included all patients undergoing primary resections for colon or rectal cancer between 2016 and 2019. Hospital factors that were examined in the study included 2-year mortality outcomes, hospital performance, specialist colorectal cancer expertise, availability of both radiotherapy and surgery, availability of robotic surgery, and research impact. In total, 44,299 patients with colorectal cancer were included, with 31,258 having colon cancer and 13,041 having rectal cancer. The study demonstrated that 27.4% and 30.2% of colon and rectal cancer patients respectively had bypassed their closest hospital to receive surgery. For individuals living in rural areas, the percentages were higher, at 29.5% and 33.6% for colon and rectal cancer respectively. Additionally, for colon cancer, there were no significant correlations between any of the hospital factors investigated and the decision to travel to a specific hospital. For rectal cancer however, patients were more likely to travel to a centre with specialist colorectal expertise (odds ratio 1.45, 95% CI 1.13-1.87, p = 0.004), more likely to a centre with robotic surgery (OR 1.43, 95% CI 1.11-1.86, p = 0.007), and less likely to a hospital with an inadequate performance rating as determined by the UK Care Quality Commission (OR 0.70, 95% CI 0.50-0.97, p = 0.03). Furthermore, patients who were older and from lower socioeconomic status (SES) backgrounds were more likely to receive care at their closest hospital, compared to younger patients and those with more advanced disease. Overall, this study demonstrated that about one-third of patients with colorectal cancer seek out hospital centres beyond their own, and that patient mortality outcomes do not seem to affect patients’ decisions to go to a more distant hospital.

Click to read the study in JAMA Surgery

Image: PD

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