“Patients diagnosed in expert hospitals were more likely to receive ablation and/or resection for [synchronous colorectal liver metastases (SCLM)] than patients diagnosed in nonexpert hospitals,” researchers of a study published in Acta Oncologica reported.
The study examined whether the discrepancies in the application of resection and/or ablation for SCLM among patients diagnosed in hospitals with varying levels of expertise have undergone any changes since the initiation of a multihospital network.
Researchers employed a retrospective design to analyze data collected from 13,981 patients diagnosed with SCLM between 2009 and 2020. The study period was divided into 3 phases: the prenetwork phase (2009-2012), the startup phase (2013-2016), and the matured-network phase (2017-2020). Data on patients’ diagnoses, treatment pathways, and hospital affiliations were obtained from a nationwide dataset.
Of the total study population, 1624 patients were diagnosed with SCLM in hospitals within the multihospital network. Among patients diagnosed in the expert hospitals of the network, 36.7% received resection and/or ablation, while only 28.3% of patients diagnosed in nonexpert hospitals underwent those specialized treatments (P<.01).
Over time, the increase in disparity in treatment utilization between expert and nonexpert hospitals was noticeable. The odds ratio (OR) of patients diagnosed in expert hospitals receiving specialized treatments compared with those in nonexpert hospitals rose from 1.38 in the prenetwork phase (P=.581) to 1.66 in the startup phase (P=.108) and further to 2.48 in the matured-network phase (P=.090). The nationwide analysis also exhibited a similar trend, with the OR increasing from 1.41 in the prenetwork phase (P=.011) to 2.23 in the startup phase (P<.001) and to 3.20 in the matured-network phase (P<.001).
The authors did acknowledge several limitations to their study, including a somewhat narrow interpretation of synchronous colorectal cancer metastases compared with certain literature that proposed a timeframe of up to 12 months after the initial colorectal cancer diagnosis. Their approach resulted in a limited selection of patients. Additionally, ongoing clinical trials during the study period may have potentially led to an increase in the number of surgical treatments.
The researchers called for further investigations. “To find out if more targeted network strategies are effective,” they concluded, “it is important to understand how the mechanisms in networks work to be able to steer network activities differently toward greater effectiveness.”