Medical Practice Variations in Cancer Surgery

The treatment of cancer is multidisciplinary; however, surgeons take an active role in the care of most cancer patients. Variation in cancer surgery may occur because care is provided by many surgeons practicing in different clinical settings. Several methods exist for assessing variations in cancer surgery including the evaluation of time trends, geographic variation, system comparisons, volume-outcome relationships, and disparities. Each of these methods is examined using examples from the literature along with specific weaknesses of each method. In addition two specific examples using population-based data from Ontario are presented which evaluate the surgical care of breast and colorectal cancer.