August 21, 2023- Patients with cancer who live in rural Pennsylvania counties appear to know that they may have better outcomes if they receive their cancer surgery at a hospital that performs a high volume of those surgeries, but still opt for lower volume hospitals closer to home when their cancer is likely less complex, according to a new analysis published today in JCO Oncology Practice by health policy scientists at the University of Pittsburgh School of Public Health.
With a shortage of experienced surgeons in rural America and rural hospital closures, providing appropriate surgical care to rural patients can be challenging. Programs and policies aim to centralize cancer services by steering surgical patients to high-volume hospitals, which are mostly located in urban areas. These policies have the potential to tie insurance reimbursements to quality metrics that include surgical volume.
However, the study findings indicate it may be necessary to incorporate additional measures — such as the complexity and severity of the cancer, as well as patient quality of life and satisfaction — when setting policies that dictate where patients can and cannot receive cancer care. Doing so could encourage hospitals to continue offering such surgeries closer to home for rural patients when possible.
Because high-volume hospitals are more likely to be located in metropolitan areas, it was not surprising to researchers that patients living in rural areas were less likely to have their cancer surgeries at them than patients living in urban areas. In the study, the fact that rural patients were traveling to high-volume hospitals for more complex cancer surgeries was telling.