ArticleAnnals of surgical oncology2022
Patterns and Impact of Fragmented Care in Stage II and III Gastric Cancer.
Article in Annals of surgical oncology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 24 citations in OpenAlex.
- Care Fragmentation following Upper Gastrointestinal and Hepatopancreatobiliary Cancer Surgery: Consequences for Patients and Healthcare Systems.Annals of surgical oncology · 2026Article
- Multi-disciplinarity in cancer care: a call for a global framework to deliver equitable and effective supportive care.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 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
- Stage analysis of gastric cancer: a bioinformatic approach.Gastroenterology and hepatology from bed to bench · 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
- Fragmentation of care in breast cancer: greater than the sum of its parts.Breast cancer research and treatment · 2024Article
- "It is not the fault of the health care team - it is the way the system works": a mixed-methods quality improvement study of patients with advanced cancer and family members reveals challenges navigating a fragmented healthcare system and the administrative and financial burdens of care.BMC health services research · 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
- Does fragmented cancer care affect survival? Analysis of gastric cancer patients using national insurance claim data.BMC health services research · 2022Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundOptimal management of stage II/III gastric cancer requires multidisciplinary care, often necessitating treatment at more than one facility. We aimed to determine patterns of "fragmented" care and its impact on outcomes, including concordance with National Comprehensive Cancer Network (NCCN) guidelines and overall survival.
methodsThe 2006-2016 National Cancer Database was queried for patients with clinical stage II/III gastric adenocarcinoma who received preoperative therapy in addition to surgery. Patients were stratified based on whether surgery and chemotherapy/chemoradiation were performed at one versus multiple facilities (termed "coordinated" and "fragmented" care, respectively). Multivariable logistic regression was performed to identify factors associated with fragmented care. Survival was compared using Kaplan-Meier and Cox proportional hazards methods.
resultsOverall, 2033 patients met study criteria: 1043 (51.3%) received coordinated care and 990 (48.7%) fragmented care. There was no significant difference in time to surgery or pathologic upstaging by care structure. On adjusted analysis, factors associated with receipt of fragmented care included increasing age and distance traveled to the treating facility. Factors associated with coordinated care included metropolitan residence and treatment at academic and high-volume centers. Fragmented care was associated with a reduction in guideline-preferred perioperative chemotherapy (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.63-0.97, p = 0.02) and increased mortality (HR 1.16, 95% CI 1.00-1.34, p = 0.05).
conclusionsFor patients with stage II/III gastric cancer, fragmented care is associated with inferior outcomes, including a reduction in preferred perioperative treatment and survival. Further work is needed to ensure equitable outcomes among patients as complex cancer care becomes more regionalized.
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