Patterns and characteristics of patients' selection of cancer surgeons

Am J Surg. 2021 May;221(5):1033-1041. doi: 10.1016/j.amjsurg.2020.09.041. Epub 2020 Oct 15.


Objective: Despite evidence of volume-outcome relationships for cancer surgery, treatment at low-volume hospitals remains common. Our objective was to evaluate whether individuals actively involved in selecting their cancer surgeon were more likely to go to hospitals recognized for quality cancer care.

Methods: Individuals diagnosed with breast, prostate and colorectal cancer in 2015 completed online surveys in 2017-2018. Participants were categorized as "directed" to a surgeon (relied on referral) or "active" (sought additional information), and hospitals were categorized by NCI-designation, CoC accreditation, and academic affiliation.

Results: Of 299 participants, 42% were active. Individuals with breast cancer were more active (aOR = 2.46,95%CI:1.32-4.59). Active participants had nonsignificantly higher odds of surgery at NCI-designated facilities (aOR = 2.04,95%CI:0.95-4.38), or academic centers (aOR = 1.51,95%CI:0.86-2.64).

Conclusions: While most participants were directed to their cancer surgeon, active participants tended to select NCI-designated/academic hospitals. Although centralization of cancer care would require altering referral patterns, decision-support resources may help patients make informed choices.

Keywords: Cancer surgery; Decision-making; High-volume hospitals; Referral patterns; Surgeon selection.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Breast Neoplasms / surgery
  • Colorectal Neoplasms / surgery
  • Decision Making
  • Female
  • Health Literacy
  • Hospitals / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Patient Preference / psychology
  • Patient Preference / statistics & numerical data*
  • Prostatic Neoplasms / surgery
  • SEER Program
  • Socioeconomic Factors
  • Surgical Oncology / statistics & numerical data*