Abstract
BackgroundLittle is known about regional variation in cancer treatment and its determinants. We compare rates of adherence to treatment guidelines for elderly patients across Texas and whether local specialist supply is an important determinant of treatment variation.MethodsPrevious literature reviewed indicated 7 recommended courses of treatment for colorectal, pancreatic, and prostate cancer. We analyzed Texas Cancer Registry data linked with Medicare claims for the years 2004 to 2007 to study patients with these cancers. We tested for unadjusted and adjusted differences in treatment rates across 22 hospital referral regions (HRR). We tested whether variation in the local supply of specialists treating each cancer was an important determinant of treatment.ResultsWe found significant differences in adjusted treatment rates across regions. For removal and examination of 12+ lymph nodes with colon cancer resection, 13 of 22 HRRs had rates significantly different from the median region. For adjuvant chemotherapy for regional colon cancer, five HRRs significantly differed from the median. For prostate cancer treatment with a favorable diagnosis, nine HRRs differed from the median HRR. Of the 7 treatments, only the local availability of surgeons was an important determinant for excision of lymph nodes for colon cancer patients.ConclusionsThere are significant variations across Texas for seven recommended cancer treatments. No one region has consistently higher or lower treatments than other regions, and local specialist supply is not an important predictor of treatment. Different factors may be determining regional variation in treatment rates across cancer types and treatment options.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1534-z) contains supplementary material, which is available to authorized users.
Highlights
Little is known about regional variation in cancer treatment and its determinants
We report the number of cancer patients eligible for each recommended treatment in each hospital referral regions (HRR) in a table in the additional file
We find 8 out of 22 HRRs in Texas have rates of lymph node removal with colon cancer surgery which are significantly different from the median region of Lubbock
Summary
Little is known about regional variation in cancer treatment and its determinants. This study compares rates of high quality treatment for patients aged 65+ across regions of Texas. Several studies have identified regional variation in treatment for individual cancer types [2,3,4,5,6,7,8,9,10]. Past studies comparing risk adjusted Medicare spending across regions give the impression that some areas tend to treat patients of all types more aggressively than others [11,12,13]. No study has simultaneously compared treatment rates for multiple cancer therapies to determine whether certain areas tend to treat patients at a higher or lower rate relative to other regions
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