Hospital safety-net burden does not predict differences in rectal cancer treatment and outcomes

Abstract

Background: Safety-net hospitals have been shown to have inferior short-term surgical outcomes. The aim of this study was to compare rectal cancer management and survival across hospitals stratified by payer mix.

Materials and methods: Rectal cancer patients (n = 296,068) were identified using the 1998-2010 National Cancer Data Base. Hospitals were grouped into safety-net burden categories, according to the proportion of patients with Medicaid or no health insurance, as follows: low-, medium-, and high-burden hospitals (HBHs). Patient and tumor characteristics, processes of care, and outcomes were evaluated, and regression analysis was used to investigate correlations between hospital safety-net burden on patient survival.

Results: HBH encountered patients with more advanced disease (P < 0.001). Despite this, stage I-III patients at HBH had equal likelihood of receiving surgery and guideline-appropriate radiation and chemotherapy (all P > 0.05). The 30-day readmissions and mortality were also similar across safety-net groups (all P > 0.05). Multivariate analysis showed no difference in survival between HBH and low-burden hospital (P = 0.164).

Conclusions: Hospital payer mix may not adversely influence management of rectal cancer. This study highlights potential areas to improve cancer care for vulnerable patient populations.

Keywords: Rectal cancer; Safety-net; Surgical outcomes.