Surgeons' volume of colorectal cancer procedures and collaborative decision-making about adjuvant therapies.
BACKGROUND
Few studies have assessed associations of surgeons' practice volume with processes of care that lead to better outcomes.


OBJECTIVE
We surveyed surgeons treating colorectal cancer to determine whether high-volume surgeons were more likely to collaborate with other physicians in decisions about adjuvant therapies.


METHODS
Surgeons caring for patients with colorectal cancer in multiple regions and health-care organizations were surveyed to assess their volume of colorectal cancer resections and participation in decisions about adjuvant chemotherapy and radiation therapy. We used logistic regression to assess physician and practice characteristics associated with surgical volume and the relation of surgical volume and these other characteristics to collaborative decision-making regarding adjuvant therapies.


RESULTS
Of 635 responding surgeons, those who identified themselves as surgical oncologists or colorectal surgeons were more likely than others to report high volume of colorectal cancer resections (P < 0.001), as were those who practiced at a comprehensive cancer center (P = 0.06) and attended tumor board meetings weekly (vs. quarterly or less, P = 0.09). Most surgeons reported a collaborative role in decisions about chemotherapy and radiation therapy. However, in adjusted analyses, higher-volume surgeons more often reported a collaborative role with other physicians in decisions about chemotherapy (P < 0.001) and radiation therapy (P < 0.001).


CONCLUSIONS
Higher-volume surgeons are more likely to report collaborating with other physicians in decisions about adjuvant therapies for patients following colorectal cancer surgery. This collaborative decision-making of higher-volume surgeons may contribute to outcome differences by surgeon volume.
Department of Surgery, daggerCenter for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
Selwyn O
SO
Rogers
John Z
JZ
Ayanian
Clifford Y
CY
Ko
Katherine L
KL
Kahn
Alan M
AM
Zaslavsky
Robert S
RS
Sandler
Nancy L
NL
Keating
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D003657:Decision Making; D006276:Health Facility Size; D006801:Humans; D007400:Interprofessional Relations; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016526:Workload
D000970:Antineoplastic Agents