title: Multimodal cancer care in poor prognosis cancers: Resection drives long-term outcomes.
abstract: OBJECTIVE
  Hospitals with high complex oncologic surgical volume have improved short-term outcomes. However, for long-term outcomes, the influence of other therapies must be considered. We compared effects of resection with other therapies on long-term outcomes across U.S. hospitals.
  
  
  METHODS
  We examined claims in the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset for patients with esophageal (EC) and pancreatic (PC) cancers between 2005-2009, with follow-up through 2011, performing multivariable Cox proportional hazards analyses. We stratified hospitals by volume and compared rates of treatments in the context of survival.
  
  
  RESULTS
  We studied 905 EC and 3,293 PC patients at 138 and 375 hospitals, respectively. For EC, resection rates were significantly higher (32.9% vs. 9.5%, P < 0.001) in the highest versus lowest volume hospitals. Adjusted survival was also statistically significantly better (48.5% vs. 43.1%, P < 0.001). For PC, resection rates were also statistically significantly higher (30.1% vs. 12.0%, P < 0.001) with higher adjusted survival (21.5% vs. 19.9%, P = 0.01). We did not find variation in rates of other cancer treatments across hospitals.
  
  
  CONCLUSIONS
  A significant association exists between long-term survival and rates of cancer-directed surgery across hospitals, without variation in rates of other therapies. Access to resection appears to be key to reducing variation in long-term survival. J. Surg. Oncol. 2016;113:599-604. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan.|Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Healy
authors.affiliation: Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan.
authors.forename: Huiying
authors.initials: H
authors.lastname: Yin
authors.affiliation: Department of Surgery, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume / Q000600:supply & distribution*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: clinical oncology; esophageal; neoplasms; pancreatic; radiation oncology; surgery