The Authors Reply

Excerpt

To the Editor—We thank Dr. Hyman for his thoughtful comments regarding our paper, which describes the status of proctectomy in the United States. In addition, we share his frustration with the pace of change and agree that a concerted effort is needed to optimize care for patients with rectal cancer. However, we disagree with the concept that what is needed is more measurement. Although it has become fashionable to reduce the importance of research conducted with administrative data, the findings of our study, specifically low rates of sphincter salvage and reestablishment of intestinal continuity, are compelling and, to quote Dr Hyman, “ring true.” Others have similarly measured important outcomes using population-based administrative data1,2 and cancer registries,3 while describing similarly alarming patterns of care for patients with rectal cancer in the United States.4 Although we agree that these data sources are not perfect, we are not seeking perfection in measurement, nor are our patients. A significant resource investment would be required to “create disease-specific tools with clinically meaningful data points and outcomes”; however, such tools would not necessarily result in improvement in quality, nor are they the most efficient way to reach this end. To develop and implement such tools, we would need to invest considerable resources and energy while delaying our true common goal: achieving real change in how patients with rectal cancer are cared for in the United States. …