Many patients receive surgical and medical oncology care from different hospitals, which is associated with higher costs, according to a study published in Cancer.

Tanvir Hussain, M.D., from Johns Hopkins University in Baltimore, and colleagues retrospectively analyzed data from the Surveillance, Epidemiology, and End Results-Medicare cohort.

Stage III colon cancer patients (9,075) diagnosed between 2000 and 2009 who had received both surgical and medical oncology care within one year of their diagnosis were categorized by the hospital at which they had undergone their cancer surgery and by their oncologist’s primary hospital.

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The researchers found that 37 percent of the patients received their surgical and medical oncology care from different hospitals.

Compared with urban patients, rural patients were less likely to receive medical oncology care from the same hospital (odds ratio, 0.62).

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Care from the same hospital was not associated with reduced all-cause or colon-cancer-specific mortality, but it was tied to lower costs (8 percent of the median cost) at 12 months (dollars saved, $5,493; 95 percent confidence interval, $1,799-$9,525).

“Reforms seeking to improve outcomes and lower costs through the integration of complex care will need to address the significant proportion of patients receiving care at more than one hospital,” the authors write.


  1. Hussain T, Chang H, Veenstra CM, et al. Fragmentation in specialist care and stage III colon cancer. Cancer. [online ahead of print]. 2015. DOI: 10.1002/cncr.29474.