Disparities in care point to need for complex cancer surgical centres
November 12, 2015
TORONTO – There is ‘tremendous’ variance in in-hospital mortality, resection rates and length of stay outcomes in high-risk cancer surgical care across Canada, says a new study commissioned by the Canadian Partnership Against Cancer.
“If our goal is to improve cancer care and outcomes, the evidence tells us that patients requiring complex surgeries can benefit from having their procedure performed at a regional centre of excellence, where these types of surgery would be performed more often,” said Dr. Christian Finley, a thoracic surgeon at St. Joseph’s Health Centre in Hamilton and lead author of the Approaches to High-Risk, Resource Intensive Cancer Surgical Care in Canada paper.
The study found notable disparities between provinces in patterns of practice and patient outcomes for surgical cancer care. In evaluating the outcome of surgical procedures for esophageal, pancreatic, liver, lung and ovarian cancers, it found up to three to four times difference in mortality rates across provinces.
Surgical resection seeks to completely remove a tumour and in many cases is the only or best chance of cure in these cancers. The paper found the likelihood of receiving a potentially curative operation in a province with high resection rates can be double that of provinces with lower rates. It noted wide differences in the length of hospital stays, a sign of system efficiency and differing hospitalization policies.
Regionalization – where high-risk, high-resource cancer surgery cases are grouped into specific centres – would not only provide more opportunities to build skills in performing complicated cancer surgeries, it would also encourage the development of high-functioning, specialized teams of nurses, anesthesiologists, radiologists and pathologists. At present, there is minimal regulation as to which procedures surgeons or hospitals can or should perform within their specialty area, or how frequently they need to perform these procedures to ensure their surgical skills remain up-to-date.
“Restructuring medical care to achieve higher volumes has shown to be beneficial in other clinical scenarios such as organ transplantation and pediatric cardiac care,” said Dr. Geoff Porter, Expert Lead in Clinical Care at the Partnership. “This paper suggests gains may be realized by considering how high risk cancer surgery is delivered in Canada. It’s imperative that we delve deeper, understand the drivers and discuss the idea of regionalization for these high-risk, high-resource surgeries.”
The study’s authors recommend the development and implementation of disease-site specific national standards of surgical cancer care; better alignment of cancer surgery within provincial cancer delivery systems; and ongoing collection of cancer surgery data to help identify benchmarks and improve surgical quality.
As part of the study, citizen panels were convened in Edmonton, Alberta; Hamilton, Ontario and Charlottetown, Prince Edward Island to gauge patient interest in regional centres of care for high-risk cancer surgeries. Participants emphasized that they would be willing to travel for high quality care, but saw a greater role for telehealth and preferred to remain at local facilities for pre- and post-surgical clinical care.
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About the Canadian Partnership Against Cancer
The Canadian Partnership Against Cancer works with Canada’s cancer community to reduce the burden of cancer on Canadians. Grounded in and informed by the experiences of those affected by cancer, the organization works with partners to support multi-jurisdictional uptake of evidence that will help to optimize cancer control planning and drive improvements in quality of practice across Canada. Through sustained effort and a focus on the cancer continuum, the organization supports the work of the collective cancer community in achieving long-term population outcomes: reduced incidence of cancer, less likelihood of Canadians dying from cancer, and an enhanced quality of life of those affected by cancer.