Collaboration Between Surgeons and Medical Oncologists and Outcomes for Patients With Stage III Colon Cancer
Collaboration Between Surgeons and Medical Oncologists and Outcomes for Patients With Stage III Colon Cancer
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DOI：
10.1200/jop.2014.003293
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发表时间：
2015-05-01
影响因子：
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通讯作者：
Pollack, Craig E.
中科院分区：
文献类型：
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作者：
Hussain, Tanvir;Chang, Hsien-Yen;Pollack, Craig E.
目的：专家之间的合作对于为具有复杂癌症需求的患者提供高价值护理至关重要。我们探讨肿瘤科医生和外科医生之间的合作如何影响需要多专科癌症护理的患者的死亡率和费用。患者和方法：这是一项针对 2000 年至 2009 年间诊断的 SEER-Medicare III 期结肠癌患者的回顾性队列研究。患者被分配给一位主要治疗外科医生和肿瘤科医生。外科医生和肿瘤科医生之间的合作是根据他们之间共享的患者数量来衡量的；这已被证明反映了医生之间寻求建议和转诊的关系。结果包括全因死亡率的危险、结肠癌特异性死亡率的亚危险以及 12 个月的护理费用。结果：共有 9,329 名患者接受了 3,623 名不同的外科医生和 2,319 名肿瘤内科医生的护理，代表了 6,827 个独特的外科医生-肿瘤内科医生对。随着专家之间共享的患者数量从 1 个增加到 5 个（第 25 个百分点到第 75 个百分点），患者的全因死亡率和结肠癌特异性死亡率提高了大约 20% 的生存获益。具体来说，肿瘤科医生和外科医生每增加一名患者，全因死亡率就会降低 5%（风险比，0.95；95% CI，0.92 至 0.97），结肠癌特异性死亡率降低 5%（亚风险比，0.95；95% CI，0.91 至 0.97）。与费用无关。结论：对于 III 期结肠癌患者来说，专家合作与较低的死亡率相关，且费用不增加。促进专家之间的正式和非正式合作可能是改善复杂癌症患者护理的重要策略。
Purpose: Collaboration between specialists is essential for achieving high-value care in patients with complex cancer needs. We explore how collaboration between oncologists and surgeons affects mortality and cost for patients requiring multispecialty cancer care.Patients and Methods: This was a retrospective cohort study of patients with stage III colon cancer from SEER-Medicare diagnosed between 2000 and 2009. Patients were assigned to a primary treating surgeon and oncologist. Collaboration between surgeon and oncologist was measured as the number of patients shared between them; this has been shown to reflect advice seeking and referral relationships between physicians. Outcomes included hazards for all-cause mortality, subhazards for colon cancer-specific mortality, and cost of care at 12 months.Results: A total of 9,329 patients received care from 3,623 different surgeons and 2,319 medical oncologists, representing 6,827 unique surgeon-medical oncologist pairs. As the number of patients shared between specialists increased from to one to five (25th to 75th percentile), patients experienced an approximately 20% improved survival benefit from all-cause and colon cancerspecific mortalities. Specifically, for each additional patient shared between oncologist and surgeon, all-cause mortality improved by 5% (hazard ratio, 0.95; 95% CI, 0.92 to 0.97), and colon cancerspecific mortality improved by 5% (subhazard ratio, 0.95; 95% CI, 0.91 to 0.97). There was no association with cost.Conclusion: Specialist collaboration is associated with lower mortality without increased cost among patients with stage III colon cancer. Facilitating formal and informal collaboration between specialists may be an important strategy for improving the care of patients with complex cancers.