title: Improved patient survivals with colorectal cancer under multidisciplinary team care: A nationwide cohort study of 25,766 patients in Taiwan.
abstract: OBJECTIVE
  The evidence of improved survival in patients of colorectal cancer (CRC) receiving multidisciplinary team (MDT) care remains inconclusive.
  
  
  METHODS
  All patients with incident CRC but no prior cancer history in 2005-2008 were included and followed till 2010. A logistic regression model was used to predict the associated factors to participate in the MDT care model. The propensity score method was included under Cox proportional hazards model to reduce potential bias and to conduct survival analyses.
  
  
  RESULTS
  In total, 25,766 patients were included; the mean follow-up period was 35.1 months. The factors associated with participating in MDT included receiving treatments at regional hospitals, at private hospitals, and stage III cancer (all p values <0.001). The favorable survival factors included participating in MDT (HR=0.91, p=0.001), age of 45-75, top-ranked income group, receiving treatments at district hospitals, or at hospitals or with doctors that had higher service volumes (all p values <0.05). Regarding individual stages, the risk of mortality was significantly lower at stage IV (HR=0.88, p=0.002).
  
  
  CONCLUSIONS
  Colorectal cancer patients with participation in MDT have a lower mortality risk; the improvements of survival exist in all colorectal cancer patients, especially in those with stage IV disease.
authors.affiliation: Department of Public Health and Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Liuying, Tainan, Taiwan. Electronic address: jjeelhsu@yahoo.com.tw.
authors.forename: Yueh-Han
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: Department of Healthcare Administration, Asia University, Taichung, Taiwan. Electronic address: ptkung@asia.edu.tw.
authors.forename: Pei-Tseng
authors.initials: PT
authors.lastname: Kung
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan. Electronic address: we761220@gmail.com.
authors.forename: Shih-Ting
authors.initials: ST
authors.lastname: Wang
authors.affiliation: Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan. Electronic address: 04969@cych.org.tw.
authors.forename: Chuan-Yin
authors.initials: CY
authors.lastname: Fang
authors.affiliation: Department of Health Services Administration, China Medical University, Taichung, Taiwan. Electronic address: wtsai@mail.cmu.edu.tw.
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000706:statistics & numerical data*; D057216:Propensity Score; D011787:Quality of Health Care; D012189:Retrospective Studies; D013534:Survival; D013624:Taiwan / Q000453:epidemiology
keywords: Colorectal cancer; Multidisciplinary team care; Propensity score method; Quality of care; Service volume; Survival