Colorectal Cancer Care Quality in a Developing Country: Insights from a Comparison of Teaching and Non-teaching Hospitals in Iran

Sep 23, 2026

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Study examines disparities in colorectal cancer (CRC) care quality in Iran by comparing teaching cancer centers (TCCs) with a high-volume, non-teaching, non-cancer center (NTNC). A collaborative registry evaluated non-metastatic CRC patients, analyzing survival using multivariate Cox regression and TMLE while accounting for stage, margins, guideline adherence for adjuvant/neoadjuvant therapy, emergency surgery, socioeconomic status, and surgical risk. Among 668 patients, TCC surgery showed higher quality of care and improved outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages17

Reading Time43 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

OPEN ACCESS Citation: Rouhollahi MR, Aghili M, Nemati S, Mohagheghi MA, Ardalan FA, Mahmoodzadeh H, et al. (2025) "Colorectal Cancer Care Quality in a Developing Country: Insights from a Comparison of Teaching and Non-teaching Hospitals in Iran". PLoS One 20(9): e0326796 . [https://doi.org/10.1371/journal.pone.0326796](https://doi.org/10.1371/journal.pone.0326796) Editor: Sina Azadnajafabad, Washington University in St Louis, UNITED STATES OF AMERICA Received: January 20, 2024 Accepted: June 4, 2025 Published: September 8, 2025 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: [https://doi.org/10.1371/journal](https://doi.org/10.1371/journal). pone.0326796 Copyright: © 2025 Rouhollahi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, RESEARCH ARTICLE “Colorectal Cancer Care Quality in a Developing Country: Insights from a Comparison of Teaching and Non-teaching Hospitals in Iran” Mohammad Reza Rouhollahi1, Mahdi Aghili2, Saeed Nemati1, Mohammad Ali Mohagheghi1, FaridAzmoudehArdalan1, Habibollah Mahmoodzadeh1, Mehrzad Mirzania1, Mohammad Shirkhoda1, Seyed Hossein Yahyazadeh3, Ahad Muhammadnejad4, SepidehAbdi1, Maedeh Zokaei Nikoo5, Kazem Zendehdel1* 1 Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran, 2 Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran, 3 Clinical Cancer Research Center, Milad Hospital, Iran University of Medical Sciences, Tehran, Iran, 4 Cancer Biology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran, 5 Department of Outcome Research, Cleveland Clinic, Ohio, United States of America * [kzendeh@tums.ac.ir](kzendeh@tums.ac.ir) Abstract Background Our study represents the first effort in the Eastern Mediterranean Region to identify disparities in the quality of colorectal cancer (CRC) care in Iran. Methods We established a collaborative registry program for non-metastatic CRC patients to evaluate survival rates between teaching cancer centers (TCCs) and a high-volume, non-teaching, non-cancer center (NTNC) . The study included a diverse patient population and considered various factors such as cancer stage, margin involvement, adherence to guidelines for adjuvant and neoadjuvant treatments, emergency surgeries, socioeconomic status, and risk of surgery. We utilized a multivariate Cox regression model and the targeted maximum likelihood estimator (TMLE) to analyze survival disparities in colorectal cancer between TCCs and the NTNC. Results We recruited 668 CRC patients, including 320 with colon cancer and 298 with rectal cancer. Patients who underwent surgery at teaching cancer centers (TCCs) displayed significantly higher quality of care and better outcomes than those treated at thenon-teaching, non-cancer center (NTNC) . The adjusted hazard ratios (HR) were 1.97 (95% CI 1.21–3.21) for colon cancer and 1.54 (95% CI 1.01–2.55) for rectal cancer. Additionally, we observed significant causal mortality risk ratios (RR) based on hospital type for overall colorectal cancer (RR = 1.42, 95% CI 1.12–1.81) and specifically PLOS One | [https://doi.org/10.1371/journal.pone.0326796](https://doi.org/10.1371/journal.pone.0326796) September 8, 2025 1 / 17 which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data availability statement: Since the patients did not consent to the public distribution of their data, and the Ethics Committee of Tehran University of Medical Sciences (TUMS) has not granted such rights to researchers, the data from this study cannot be published in pub

FAQs

What is the study's main goal regarding colorectal cancer care in Iran?

To identify disparities in the quality of colorectal cancer (CRC) care in Iran by comparing teaching cancer centers with a high-volume non-teaching, non-cancer center.

How were patient outcomes analyzed between teaching and non-teaching hospitals?

Non-metastatic CRC patients were evaluated through a collaborative registry program, and survival disparities were analyzed using multivariate Cox regression and TMLE while considering multiple clinical and sociodemographic factors.

What did the study find about surgery at teaching cancer centers versus the NTNC?

Patients treated at teaching cancer centers received significantly higher quality of care and had better outcomes, reflected in higher adjusted hazard ratios and increased causal mortality risk ratios by hospital type.

Sep 23, 2026

Uploaded by Aran