title: Rectal cancer and teaching hospitals: hospital teaching status affects use of neoadjuvant radiation and survival for rectal cancer patients.
abstract: BACKGROUND
  For rectal cancer, it is unknown how use of radiation, treatment cost, and survival differ based on hospital teaching designation.
  
  
  METHODS
  Private insurance claims data linked with the Pennsylvania Cancer Registry were used to identify rectal cancer patients undergoing surgery from 2004 to 2006. Patients with missing data of interest were excluded. Hospitals were characterized as follows: large (≥200 beds) versus small size (<200 beds), teaching versus nonteaching, and urban versus rural. Logistic regression was used to model the use of neoadjuvant radiotherapy, and Cox proportional hazards models were used to compare cancer-specific survival between hospital types.
  
  
  RESULTS
  A total of 432 patients were analyzed. There was no difference in the distribution of cancer stages among the various hospital types (all p > 0.20). Teaching hospitals were associated with significantly higher utilization of neoadjuvant radiotherapy for stage II and III cancers compared with nonteaching facilities (57 vs. 28 %; p < 0.0001). On multivariate analysis, teaching status was the only hospital designation associated with use of neoadjuvant radiation (p < 0.001); hospital size and rural/urban designation were not significant. Nonteaching hospitals were more likely to use adjuvant radiotherapy for stage II and III disease (13 vs. 30 %; p < 0.01). Teaching hospitals had lower odds of death from rectal cancer when evaluating all stages [hazard ratio (HR) = 0.35; p < 0.0001] with similar costs of inpatient treatment (teaching: US $30,769 versus nonteaching: US $26,892; p = 0.22).
  
  
  CONCLUSIONS
  Teaching designation was associated with higher incidence of neoadjuvant radiotherapy for stage II and III disease, with improved cancer-specific survival compared with nonteaching hospitals, and with similar treatment costs.
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. dstewart@hmc.psu.edu
authors.forename: David B
authors.initials: DB
authors.lastname: Stewart
authors.forename: Christopher
authors.initials: C
authors.lastname: Hollenbeak
authors.forename: Susan
authors.initials: S
authors.lastname: Desharnais
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.forename: Patricia
authors.initials: P
authors.lastname: Gladowski
authors.forename: Vickie L
authors.initials: VL
authors.lastname: Goff
authors.forename: Li
authors.initials: L
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006780:Hospitals, Rural / Q000639:trends; D006784:Hospitals, Teaching / Q000639:trends*; D006786:Hospitals, Urban / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality*; D009367:Neoplasm Staging; D010414:Pennsylvania; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000401:mortality*; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult