CHARACTERISTICS OF HIGH PERFORMING FACILITIES TREATING PATIENTS WITH COLORECTAL LIVER METASTASES: AN ANALYSIS OF THE NATIONAL CANCER DATABASE
Chad Barnes*, Erin Ward, Jennifer Merrill, Nathaniel Verhagen, Veronica Loy, Callisia N. Clarke, Kathleen Christians, Ugwuji N. Maduekwe, Thomas C. Gamblin, Anai N. Kothari
Medical College of Wisconsin, Milwaukee, WI
Introduction: For patients with colorectal liver metastases (CRLM), the facility in which care is received may impact oncologic outcomes. We measured variation in survival based on treatment facility and identified facility-level factors that predict high performance in the treatment of patients with CRLM.
Methods: Patients with stage IV colorectal cancer with isolated liver metastases were identified in the National Cancer Database (NCDB) and clustered by treatment facility. Treating facilities were divided into quartiles based on the median overall survival (OS) of patients treated at the facility. Facilities in the top quartile were classified as high performing facilities (HPF) and all others were classified as non-HPF. Multivariable models were used to measure the association between facility features and high performance.
Results: Between 2010 and 2015, 1125 facilities were identified that met our inclusion criteria; 282 (25%) were HPF and 843 (75%) were non-HPF. Of the 282 HPF, 86 (31%) were academic centers, whereas only 117 (13%) of the 843 non-HPF were academic centers (p<0.001). The median OS of patients treated at HPF was 37.4 months as compared to 15.6 months for patients treated at non-HPF. In an adjusted model, the number of treatment modalities utilized (OR 1.34, 95%CI 1.15-1.55, p<0.001) and volume of patients treated (OR 3.29, 95%CI 1.33-8.10, p=0.01) were facility factors most strongly associated with being a HPF (Figure).
Conclusion: Survival for patients with CRLM varies significantly by treating facility and HPF can be distinguished from non-HPF based on facility factors. HPF are characterized by higher volume and an increased number of available treatment modalities.
Figure. Differential features of HPF vs. non-HPF that treat patients with CRLM.
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