Hospital Volume Predicts Guideline Concordant Care in Stage III Esophageal Cancer.

ABSTRACT Background Esophageal cancer is a deadly disease requiring multidisciplinary coordination of care and surgical proficiency for adequate treatment. We hypothesize that quality of care is varied nationally. Methods From published guidelines, we developed quality measures for management of stage III esophageal cancer: utilization of neoadjuvant therapy, surgical sampling of at least 15 lymph nodes, resection within 60 days of chemotherapy and/or radiation, and completeness of resection. Measure adherence was examined across 1345 hospitals participating in the National Cancer Database from 2004 to 2016. We examined the association of volume, program accreditation, safety net status, geographic region, patient travel distance on adequate adherence (≥85% of patients are adherent) using logistic regression modeling. Results The rate of adequate adherence was worst in nodal staging (12.6%) and highest for utilization of neoadjuvant therapy (84.8%). Academic programs had the highest rate of adequate adherence for induction therapy (77.2%, p Conclusions Care provided at higher volume and academic facilities was more likely to be guideline concordant in some areas but not others. Understanding the processes that support the delivery of guideline concordant care may provide valuable opportunities for improvement.