Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

In Rectal Cancer, Fragmented Care Linked to Lower Survival

Key clinical point: Centralized cancer care could be compromising care for rural patients.

Major finding: Fragmented care for rectal cancer was associated with higher mortality (HR, 1.07).

Study details: A retrospective analysis of 28,227 patients.

Disclosures: The study received no external funding. Dr. Freischlag and Dr. Lawson reported no relevant conflicts of interest.


Freischlag K et al. J Am Coll Surg. 2019 Oct;229(4):Suppl 1, S52.


Health care in the United States is highly fragmented. Fragmented care is especially challenging for those who do not live in proximity to specialists. Previous studies have highlighted the poorer outcomes associated with fragmented cancer care. Olivere et al. queried the National Cancer Database to determine if there was an association between fragmentation of care (defined by radiation delivery at a different location than surgery) and outcomes. They discovered that fragmented care was associated with poorer survival, even in academic centers. These findings suggest that coordination between health systems is desperately needed for optimal patient care.—Mark A. Klein, MD