Favoring High-Volume Hospitals May Disadvantage Rural Cancer Patients

Patients in Rural Pennsylvania Counties Opt for Lower Volume Hospitals for Less Complex Cancer Surgeries, Despite Knowledge of Better Outcomes at High-Volume Hospitals

8/17/2023

Introduction

Patients with cancer in rural Pennsylvania counties tend to choose lower volume hospitals closer to home for their cancer surgeries, even though they are aware that high-volume hospitals have better outcomes, according to a study published in JCO Oncology Practice by health policy scientists at the University of Pittsburgh School of Public Health.

Sustainable Development Goals (SDGs)

1. Goal 3: Good Health and Well-being
2. Goal 10: Reduced Inequalities
3. Goal 17: Partnerships for the Goals

Challenges in Rural Cancer Care

Providing appropriate surgical care to rural cancer patients is challenging due to a shortage of experienced surgeons in rural areas and the closure of rural hospitals. Current programs and policies aim to centralize cancer services by directing surgical patients to high-volume hospitals, mostly located in urban areas. These policies may tie insurance reimbursements to quality metrics, including surgical volume. However, the study suggests that additional measures, such as the complexity and severity of the cancer, as well as patient quality of life and satisfaction, should be considered when setting policies for cancer care. This approach could encourage hospitals to continue offering surgeries closer to home for rural patients when feasible.

Study Details

The study analyzed statewide data from the Pennsylvania Health Care Cost Containment Council on adult patients with various types of cancer who underwent surgery between 2017 and 2020. The researchers classified hospitals as “high-volume” based on the number of surgeries performed for each cancer type. The study compared the choices of rural and urban patients in receiving cancer surgeries at high-volume hospitals.

Findings

• Rural patients with pancreatic or esophageal cancers, which require complex surgeries, were more likely to receive their surgeries at high-volume hospitals compared to urban patients.
• For brain and stomach cancer, the rates of receiving surgeries at high-volume hospitals were similar between rural and urban patients.
• For most other cancer types that may involve less complex surgeries, rural patients were less likely than urban patients to choose high-volume hospitals, despite evidence linking higher surgical volume to improved outcomes.

Considerations for Policy

The researchers emphasize the need to consider the consequences of centralizing cancer surgery solely based on hospital volume. Factors such as quality of life, continuity of care, and equity in access to cancer care should also be taken into account. Strategies that promote equitable access to cancer surgery for underserved populations can help address disparities in cancer care.

Conclusion

The study highlights the importance of considering multiple factors, including complexity of cancer, patient preferences, and quality of life, when determining policies for cancer care. By incorporating these considerations, healthcare systems can work towards achieving the Sustainable Development Goals of good health and well-being, reduced inequalities, and partnerships for the goals.

PHOTO DETAILS: (click images for high-res versions)

Top photo
CREDIT: University of Pittsburgh
CAPTION: Lindsay Sabik, Ph.D.

Bottom photo
CREDIT: Nicole Ober/University of Pittsburgh
CAPTION: Haleh Ramian, Ph.D.

SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being
• SDG 10: Reduced Inequalities
• SDG 17: Partnerships for the Goals

The issues highlighted in the article are related to healthcare access and equity, which align with SDG 3. The focus on rural patients and the disparities in accessing high-volume hospitals also relates to SDG 10, as it addresses reducing inequalities in healthcare. Additionally, the mention of programs and policies that aim to centralize cancer services and the need for incorporating additional measures in setting policies reflects the importance of partnerships (SDG 17) to achieve optimal patient outcomes and experiences.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality, and affordable essential medicines and vaccines.
• Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
• Target 17.16: Enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships that mobilize and share knowledge, expertise, technology, and financial resources.

The article highlights the need for universal health coverage and access to quality healthcare services for rural patients with cancer. This aligns with Target 3.8 of SDG 3. The disparities in accessing high-volume hospitals and the potential impact on quality of life for rural patients reflect the need to address social and economic inclusion, as stated in Target 10.2 of SDG 10. The mention of programs and policies that aim to centralize cancer services and the call for incorporating additional measures in setting policies highlight the importance of partnerships and knowledge-sharing to achieve optimal patient outcomes, which relates to Target 17.16 of SDG 17.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, there are indicators mentioned in the article that can be used to measure progress towards the identified targets:

• Indicator: Percentage of rural patients with cancer who receive surgery at high-volume hospitals
• Indicator: Patient quality of life and satisfaction with cancer surgery
• Indicator: Availability and accessibility of high-volume hospitals in rural areas

The percentage of rural patients with cancer who receive surgery at high-volume hospitals can be used as an indicator to measure progress towards Target 3.8 of SDG 3. This indicator reflects the extent to which rural patients have access to quality surgical care. Patient quality of life and satisfaction with cancer surgery can serve as indicators to assess the impact of healthcare policies on social and economic inclusion, as stated in Target 10.2 of SDG 10. Additionally, the availability and accessibility of high-volume hospitals in rural areas can be measured to evaluate progress towards Target 17.16 of SDG 17, as it reflects the effectiveness of partnerships and knowledge-sharing in improving healthcare access for underserved populations.

4. Table: SDGs, Targets, and Indicators

Behold! This splendid article springs forth from the wellspring of knowledge, shaped by a wondrous proprietary AI technology that delved into a vast ocean of data, illuminating the path towards the Sustainable Development Goals. Remember that all rights are reserved by SDG Investors LLC, empowering us to champion progress together.

Source: upmc.com

Join us, as fellow seekers of change, on a transformative journey at https://sdgtalks.ai/welcome, where you can become a member and actively contribute to shaping a brighter future.