Is community hospital cancer center an oxymoron? Do cancer hospitals have better outcomes?

Back in the 1990s while I was President & CEO of LibertyHealth/ Jersey City Medical Center (a teaching hospital affiliated with Mount Sinai School of Medicine), a neighboring community purchased a linear accelerator and declared itself a Cancer Center, including signs on the New Jersey Turnpike saying “exit here” for cancer care.

And I remember when a friend with possible breast cancer was about to pick a breast surgeon who was in-network (though we didn’t use that terminology then) rather than one based on credentials, hospital affiliations, and experience.

With increasing frequency community hospitals market their cancer centers.

The information below can help you evaluate and weigh cancer care options!

The “gold standard”! National Cancer Institute Designated Cancer Centers.

“The NCI Cancer Centers Program is one of the anchors of the nation’s cancer research effort. There are currently 69 NCI-Designated Cancer Centers, located in 35 states and the District of Columbia, that form the backbone of NCI’s programs for studying and controlling cancer. At any given time, hundreds of research studies are under way at the cancer centers, ranging from basic laboratory research to clinical assessments of new treatments. Many of these studies are collaborative and may involve several cancer centers, as well as other partners in industry and the community.” (A)

To find an NCI Designated Cancer Center click on http://www.cancer.gov/research/nci-role/cancer-centers/find

“Accreditation by the Commission on Cancer (CoC), a quality program of the American College of Surgeons, demonstrates a cancer program’s commitment to providing high-quality, multidisciplinary, patient-centered cancer care.

CoC accreditation is nationally recognized by organizations, including the National Cancer Institute, Centers for Medicare & Medicaid Services, National Quality Forum, American Cancer Society, and The Joint Commission, as having established data-driven performance measures for the provision of quality cancer care.” (B)

There are 9 CoC designations. Comprehensive Community Cancer Program (CCCP).Community Cancer Program (CCP) .Academic Comprehensive Cancer Program (ACAD). Integrated Network Cancer Program (INCP). Veterans Affairs Cancer Program (VACP). NCI-Designated Comprehensive Cancer Center Program (NCIP). Pediatric Cancer Program (PCP). Hospital Associate Cancer Program (HACP). Free Standing Cancer Center Program (FCCP). (C)

Comprehensive Community Cancer Program (CCCP). Accessions more than 500 or more newly diagnosed cancer cases each year. Full range of diagnostic and treatment services provided either on-site or by referral. Participates in cancer-related clinical research either by enrolling patients in cancer-related clinical trials or by referring patients for enrollment at another facility or through a physician’s office. Training resident physicians is optional.

Community Cancer Program (CCP). Accessions more than 100 but fewer than 500 newly diagnosed cancer cases each year. Full range of diagnostic and treatment services provided, but referral for a portion of diagnosis or treatment may occur. Participates in cancer-related clinical research either by enrolling patients in cancer-related clinical trials or by referring patients for enrollment at another facility or through a physician’s office. Training resident physicians is optional.

Academic Comprehensive Cancer Program (ACAD).Provides postgraduate medical education in at least four program areas, including internal medicine and general surgery. Accessions more than 500 newly diagnosed cancer cases each year. Full range of diagnostic and treatment services either on-site or by referral. Participates in cancer-related clinical research either by enrolling patients in cancer-related clinical trials or by referring patients for enrollment at another facility or through a physician’s office.

Hospital Associate Cancer Program (HACP). Accessions 100 or fewer newly diagnosed cancer cases each year. Limited range of diagnostic and treatment services available on-site. Other services are available by referral. Clinical research is not required. Training resident physicians is optional.

Free Standing Cancer Center Program (FCCP). Facility is a non–hospital-based program and offers at least one cancer-related treatment modality. Full range of diagnostic and treatment services is available by referral. Referral to CoC-accredited cancer program(s) is preferred. Participation in cancer-related clinical research is encouraged but not required. Patients may be enrolled in cancer-related clinical trials either at the facility or by referring patients for enrollment at another facility or through a physician’s office. Training resident physicians is optional. No minimum caseload requirement for this category.

To find a CoC accredited cancer program click on https://www.facs.org/search/cancer-programs

Finally, there is an ongoing debate whether or not Cancer Hospitals have better outcomes than   hospitals that have cancer programs as part of a broader array of clinical activity.

Perhaps not unsurprisingly studies done by Cancer Hospitals suggest better outcomes in cancer specialty hospitals. (D) (E) For example, one states: “In our analysis, we also show large and persistent risk-adjusted differences in cancer treatment outcomes associated with the type of treating hospital. The findings suggest that compared with community hospitals, survival appears to be superior for patients treated at PPS-exempt cancer hospitals, at NCI-designated cancer centers, and at academic teaching hospitals—all findings consistent with prior reports……..”(F)

Yet a 2014 article notes: “…..in cancer there are lots of metrics, but no settled-on methodology for measuring treatment performance and comparing treatment outcomes between institutions, care settings, or providers. (G)

Some resources to consider:

– National Cancer Institute. How To Find a Doctor or Treatment Facility If You Have Cancer. Click on http://www.cancer.gov/about-cancer/managing-care/services/doctor-facility-fact-sheet

– The American Cancer Society How to Choose a Hospital: Worksheet. Click on http://www.cancer.org/acs/groups/cid/documents/webcontent/003292-pdf.pdf

– Choosing Your Cancer Treatment Hospital. How can you tell a good cancer treatment hospital from a mediocre one? Click on http://www.webmd.com/cancer/features/choosing-your-cancer-treatment-hospital

(A) http://www.cancer.gov/research/nci-role/cancer-centers

(B) https://www.facs.org/quality-programs/cancer/coc/apply/benefitscoc

(C) https://www.facs.org/quality-programs/cancer/coc/apply/categories

(D) https://www.mskcc.org/blog/msk-study-examines-care-outcomes-among-u-s-hospitals

(E) https://www.fredhutch.org/en/news/center-news/2015/11/cancer-center-patients-live-longer.html

(F) http://oncology.jamanetwork.com/article.aspx?articleid=2451426

(G) http://jop.ascopubs.org/content/10/3/215.full

 

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