ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2021
Does Fragmentation of Care in Locally Advanced Rectal Cancer Increase Patient Mortality?
Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Divided care, diminished outcomes? The impact of care fragmentation on survival in glioblastoma.Journal of neuro-oncology · 2026Article
- Multi-institutional care is associated with improved survival in biliary tract cancer.Journal of gastrointestinal oncology · 2026Article
- Association Between Fragmentation of Care and Delivery of Adjuvant Chemotherapy in Patients Traveling to High-Volume Hospitals for Pancreatic Adenocarcinoma.Annals of surgical oncology · 2026Article
- Impact of fragmented care on cancer outcomes among korean women with breast and cervical cancer: a focus on regional and economic disparities.International journal for equity in health · 2025Article
- Fragmentation of Multimodal Rectal Cancer Care: A Population-Level Retrospective Cohort Study.Journal of surgical oncology · 2025Article
- Fragmented Care and Guideline-Concordant Treatment in Locally Advanced Cervical Cancer.Obstetrics and gynecology · 2025Article
- Fragmentation of care in breast cancer: greater than the sum of its parts.Breast cancer research and treatment · 2024Article
- Association of polydoctoring and mortality among persons over 85 years with multimorbidity: a prospective cohort study in Japan.BJGP open · 2024Article
- Fragmentation of Care in Patients with Peritoneal Metastases Undergoing Cytoreductive Surgery.Annals of surgical oncology · 2024Article
- Multi-institutional Care in Clinical Stage II and III Esophageal Cancer.The Annals of thoracic surgery · 2023Article
- Is Fragmented Cancer Care Associated With Medical Expenditure? Nationwide Evidence From Patients With Lung Cancer Using National Insurance Claim Data.International journal of public health · 2023Article
- Fragmentation of Care in Pancreatic Cancer: Effects on Receipt of Care and Survival.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2022Article
- Care Fragmentation in Patients with Differentiated Thyroid Cancer.World journal of surgery · 2022Article
- Fragmentation of care and colorectal cancer survival in South Korea: comparisons according to treatment at multiple hospitals.Journal of cancer research and clinical oncology · 2022Article
- Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer.Annals of surgical oncology · 2022Article
- Impact of care fragmentation on the outcomes of patients receiving neoadjuvant and adjuvant therapy for pancreatic adenocarcinoma.Journal of surgical oncology · 2022Article
- Fragmentation of Care Among Black Women With Breast Cancer and Comorbidities: The Role of Health Systems.JCO oncology practice · 2021Article
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Authors and funding
6 authors.
Funding
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Abstract
objectiveTo evaluate health care fragmentation in patients with stage II and III rectal cancers.
backgroundFragmentation of care among multiple hospitals may worsen outcomes for cancer patients.
methodsNational Cancer Database was queried for adult patients who underwent radiation and surgery for locally advanced (stage II-III) rectal adenocarcinoma from 2006 to 2015. Fragmented care was defined as receiving radiation at a different hospital from surgery. Descriptive statistics characterized patients, and survival probability was plotted using the Kaplan-Meier method and a Cox proportional hazards model.
resultsA total of 37,081 patients underwent surgery and radiation for stage II-III rectal cancer from 2006 to 2015 (24,102 integrated care vs. 12,979 fragmented care). Patients who received fragmented care (hazard ratio [HR] 1.105; 95% CI 1.045-1.169) had a higher risk of mortality. Patients who received at least surgery (HR 0.84; 95% CI 0.77-0.92) at academic hospitals had a lower risk of mortality. Academic hospitals had a higher proportion of patients with fragmented care (38.0 vs. comprehensive community 32.8% vs. community 33.8%, p < 0.001). Within academic hospitals, fragmented care portended worse survival (integrated academic 80.0% vs. fragmented academic 76.7%, p = 0.0002). Fragmented care at academic hospitals had increased survival over integrated care at community hospitals (fragmented academic 76.7 vs. integrated community 72.2%, p = 0.00039).
conclusionsIn patients with stage II-III rectal cancer, patients who have integrated care at academic hospitals or at least surgery at academic centers had better survival. All efforts should be made to reduce care fragmentation and surgery at academic centers should be prioritized.
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