Cancer treatment a crapshoot across Texas
There might seem no better place for cancer care than Houston, but a new study has found treatment of the disease is a crapshoot across Texas.
The study, conducted by Rice University and MD Anderson Cancer Center researchers, found that no one region in Texas is consistently better or worse at following treatment guidelines and that regions with high rates of success treating one cancer type cannot be assumed to excel in other areas.
“Texans are no better off in one city versus another in terms of treatment across a broad range of cancers,” said Vivian Ho, chair in health economics at Rice’s Baker Institute for Public Policy and study co-author. “One might have expected Houston residents to receive better treatment because of MD Anderson’s presence, for instance, but the data didn’t support that.”
The study, which looked at treatment for elderly patients, found regional variations by cancer subtypes were not due to the availability of treatment specialists or the presence of teaching hospitals. It found Houston cancer treatment was about average overall.
Ho said any beneficial effects brought to Houston by the presence of MD Anderson could be offset by a large number of local patients receiving sub-optimal treatment elsewhere, given the elite cancer center only cares for 25 percent of the region’s Medicare patients with cancer. She also said it’s possible not all MD Anderson doctors follow accepted treatment guidelines.
Previous research had found significant percentages of cancer patients receive sub-optimal care, but the new study is the first to suggest the problem occurs haphazardly. The authors said Texas’ demographic and geographic diversity and the absence of obvious explanations for treatment differences suggests such variation likely occurs elsewhere around the nation too.
The study, published in the journal BMC Health Services Research, analyzed treatment data for 2004 to 2007 for colorectal, pancreatic and prostate cancer across Texas’ 22 regional health-care markets. It compared adjusted and unadjusted rates of appropriate treatment, based on Texas Cancer Registry data linked with Medicare claims, with seven recommended regimens for the three cancer types.
Some examples: The highest rate for following guidelines that call for “watchful waiting” instead of treatment in low-risk prostate cancer was only 36 percent and that came in a region, Harlingen, that had the lowest rate, 68 percent, for following guidelines in high-risk prostate cancer. The state’s average for surgical removal of pancreatic cancer that hasn’t spread is only 41 percent, and more than half of Texas regions were either significantly above or below average at following guidelines for removal of a sufficient number of lymph nodes in colon cancer surgery.
The study’s authors called for more emphasis to be placed on continuing medical-education programming that disseminates recent guideline changes to physicians.
todd.ackerman@chron.com twitter.com/ChronMed