Background: Many rectal cancer patients are treated at small, low-volume hospitals despite evidence that better outcomes are associated with larger, high-volume hospitals.Objectives: Examine trends of rectal cancer patients receiving care at large hospitals, determine patient characteristics associated with treatment at large hospitals, and assess relationships between treatment at large hospitals and guideline-recommended therapy.Design: This study was a retrospective cohort analysis to assess trends in rectal cancer treatment.

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BACKGROUND: Despite evidence of superior outcomes for rectal cancer at high-volume, multidisciplinary cancer centers, many patients undergo surgery in low-volume hospitals.OBJECTIVE: This study aimed to examine considerations of former patients with rectal cancer when selecting their surgeon and to evaluate which considerations were associated with surgery at high-volume hospitals. DESIGN: In this retrospective cohort study, patients were surveyed about what they considered when selecting a cancer surgeon. SETTINGS: Study data were obtained via survey and the statewide Iowa Cancer Registry. PATIENTS: All eligible individuals diagnosed with invasive stages II/III rectal cancer from 2013 to 2017 identified through the registry were invited to participate. MAIN OUTCOME MEASURES:The primary outcomes were the characteristics of the hospital where they received surgery (ie, National Cancer Institute designation, Commission on Cancer accreditation, and rectal cancer surgery volume).RESULTS: Among respondents, 318 of 417 (76%) completed surveys. Sixty-nine percent of patients selected their surgeon based on their physician's referral/ recommendation, 20% based on surgeon/hospital reputation, and 11% based on personal connections to the surgeon. Participants who chose their surgeon based on reputation had significantly higher odds of surgery at National Cancer Institute-designated (OR 7.5; 95% CI, 3.8-15.0) or high-volume (OR 2.6; 95% CI, 1.2-5.7) hospitals than those who relied on referral.LIMITATIONS: This study took place in a Midwestern state with a predominantly white population, which limited our ability to evaluate racial/ethnic associations.CONCLUSION: Most patients with rectal cancer relied on referrals in selecting their surgeon, and those who did were less likely to receive surgery at a National Cancer Institute-designated or high-volume hospitals compared to those who considered reputation. Future research is needed to determine the impact of these decision factors on clinical outcomes, patient satisfaction, and quality of life. In addition, patients should be aware that relying on physician referral may not result in treatment from the most experienced or comprehensive care setting in their area. See

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Background Black people experience excess cervical and colorectal (CRC) cancer burden. Racial residential segregation, one measure of exposure to racism, is a potential driver of these inequities. To achieve cancer equity, it is crucial to better understand the role of racism and cancer prevention and early detection behaviors, including cancer screening. We assessed the association of exposure to Black residential segregation and cancer screening among Black and White adults. Methods This was a retrospective cohort study using electronic medical record data from patients who were members of the Population-based Research to Optimize the Screening Process (PROSPR) cohort. The sample included non-Hispanic (NH) Black or NH White average-risk urban adults at five U.S. healthcare settings who were eligible and due for cervical cancer screening (women aged 21-65 years) or CRC screening (50-75 years) when they had a primary care appointment (cohort entry) from 2010-2012. Black residential segregation was measured using sample-based quartiles of the local exposure and isolation (LEx/Is) metric comprising census-tract level data from 2008-2012 American Community Survey. The outcome was receipt of cervical cancer screening (completion of Pap or Pap/human papillomavirus [HPV] co-test) or CRC screening (completion of FIT/gFOBT, sigmoidoscopy, or colonoscopy) within 3 years of cohort entry. Multilevel logistic regression was used to calculate association of segregation and screening while adjusting for patient- and census-travel level covariates (age, race, sex, year of cohort entry, comorbidities, healthcare system, and census tract level poverty rate.) Results Of 164,238 and 652,719 patients eligible and due for cervical cancer or CRC screening respectively, 106,753 (65.0%) and 465,042 (71.2%) received timely screening. Black patients (6.4% of cervical screening and 15.7% of CRC screening sample), compared to White patients, were more likely to live in neighborhoods in the highest quartile of Black segregation (cervical sample: 44.1% vs. 17.6%; CRC sample: 51.8% vs. 19.4%). Greater exposure to segregation was associated with lower odds of cervical cancer screening (Quartile [Q]4 vs. Q1 odds ratio [OR]=0.92; 95% CI 0.89-0.94) and CRC screening (Q4 vs. Q1 OR=0.91; 95% CI 0.89-0.92) in unadjusted models; these associations were attenuated in adjusted models for cervical (Q4 vs. Q1 adjusted OR[aOR]=0.99; 95%CI=0.95-1.03) and CRC screening (Q4 vs. Q1 aOR=1.0; 95% CI 0.97-1.02). Notably, in adjusted models for both screening types, higher census tract level neighborhood poverty rate was associated with lower odds of screening, and Black (vs. White) race was associated with higher odds of cervical cancer screening but lower odds of CRC screening. Discussion In this study within five healthcare systems, Black residential segregation was not associated with screening after adjustment for other variables. Additional analyses will assess potential for effect measure modification by patient race, healthcare system, and other factors. Citation Format: Sandi L. Pruitt, Lynn N. Ibekwe, Kaitlin Todd, Erica S. Breslau, Andrea N. Burnett-Hartman, Cheryl R. Clark, Natalie J. Del Vecchio, Jennifer S. Haas, Stacey Honda, Christopher I. Li, Rachel L. Winer, Christine Neslund-Dudas, Rachel Issaka. Association of racial residential segregation and screening uptake for cervical and colorectal cancer among Black and White patients in five diverse U.S. healthcare systems [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A114.