Patient Characteristics, Hospital Surgery Volume and Oncologist Visit among Elderly Stage II Colon Cancer

Objectives: Hospital surgery volume may be related to higher quality of care. We examined the interaction between patient characteristics and hospital surgery volume in predicting oncologist visit post surgery among stage II colon cancer patients.

Methods: Patients aged 66-79 from 2000 to 2005 SEER-Medicare data were included (n=6,944). Oncologist visit was defined as visiting an oncologist or any physician who had administered chemotherapy. Hospital volume was based on surgery counts for colon cancer of all stages. Generalized linear mixed model with hospital as the cluster variable was used.

Results: Most of the patients (77%) visited an oncologist after surgery. The rates of oncologist visit were similar between those who were treated in large volume hospitals and those in small or moderate volume hospitals. African-Americans, those with state medical subsidy, living alone, or living in rural areas were less likely to have surgery performed in large volume hospitals. After adjusting for comorbidities and tumor characteristics, the difference in oncologist visit rate by patient's socioeconomic status was much larger when surgery was done in large volume hospitals than in small or moderate volume hospitals.

Conclusion: Surgery done in large volume hospitals did not guarantee better access to care to an oncologist after colon surgery, especially for patients with low socioeconomic status.