title: Use of adjuvant radiotherapy at hospitals with and without on-site radiation services.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Michigan Surgical Collaborative for Outcomes Research and Evaluation, Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA. wongsl@ umich.edu
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
authors.forename: Yongliang
authors.initials: Y
authors.lastname: Wei
authors.forename: John D
authors.initials: JD
authors.lastname: Birkmeyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate