Patients treated at cancer centers live longer: study

Even in cancer care, it’s location, location, location.

Patients treated at one of a handful of specialized cancer centers collectively had a 9 percent higher survival rate over five years when compared to cancer patients treated at community hospitals, a recent study showed.

While the study’s authors plan more analysis to better grasp the disparity, they posed several theories to explain the stronger outcomes among 11 “freestanding” cancer hospitals they measured. Those 11 centers included Seattle Cancer Care Alliance, the treatment arm of Fred Hutchinson Cancer Research Center. 

Appelbaum, who was not involved in the study, said he has some theories for the measured differences in survival rates among the hospital groups.

“In general, each of the PPS-exempt centers see many more cancer patients than are seen at other [medical] facilities. There are innumerable examples in medicine where outcomes improve with volume," he said. "In part, because of the larger volumes, the PPS-exempt centers usually create teams of physicians that are dedicated to a single type of cancer – for example, we have seven or eight medical oncologists who see nothing but breast cancer; I restrict my practice to acute leukemia.

“… Now, try and imagine a busy clinician at a community hospital who in one day may see several cases of lung, colon, and breast cancer, and may see an uncommon form of leukemia once or twice a year. How can such a person possibly keep up in all of the diseases?”

What’s more, for doctors at cancer centers, “the mission is cancer,” said Dr. David Pfister, lead author and chief of head and neck oncology at Memorial Sloan Kettering Cancer Center – one of the 11 cancer-specialty facilities where outcomes were assessed against more than 5,000 other U.S. hospitals.

But within that focused mission, there is an array of cancer-specialty groups that fuel expertise among physicians, Pfister said.

“For example, all I see are cancers from the neck up and below the brain, for the most part,” Pfister said. “I have an enormous amount of experience that is incrementally higher than what you’re going to get in a community practice where you might see the particularly rare tumors every once in a while. [Here], they become almost a regular occurrence. It allows you to know the literature, to get a sense of clinical behavior. … Clearly, you’re in a position to do clinical investigation into it.”

Appelbaum cited three more general distinctions that tend to separate specialized cancer centers, like SCCA, from hospitals in the other three groups:

• Doctors at large cancer hospitals have access to the newest laboratory and imaging facilities, which are overseen in-house by individuals specializing in cancer. At most community hospitals, specimens are sent away to commercial laboratories.

• At large cancer centers, interdisciplinary teams work together to create pathways that all adhere to and offer the best outcomes. At SCCA, for example, the lung cancer group includes surgeons, medical oncologists, radiation oncologists, pathologists and radiologists. At community hospitals, each practitioner treats patients in his or her own way.

• At large cancer centers, there’s access to the newest therapies while they are still being studied – and before they become available to the general public.

The Sloan Kettering researchers also found that patients treated at the 11 PPS-exempt hospitals had “a 10 percent lower chance of dying in the first year” than did patients treated at the more than 4,800 facilities that included community hospitals – 18 percent versus 28 percent.

That gap alone “is substantial and represents potentially preventable deaths of cancer patients,” Dr. Peter Bach, director of Sloan Kettering’s Center for Health Policy & Outcomes, said in a released statement. He was a senior author of the study.

“… A next step would be to figure out the mechanics underpinning it. Is it due to readmissions or mortality rates after surgery? Are people having severe side effects keeping them from finishing the chemotherapy that benefits them? We need to break down the data and figure out where the gaps in care are, and none of it is simple,” Bach said.

Can the 11 PPS-exempt hospitals share any lessons with other medical centers so that, theoretically, all cancer patients can access the same level of care?

“I suspect some of these approaches can begin to be applied in the community setting, but I don't think all of them can,” Appelbaum said. “We have level-1 trauma centers for a reason. If a patient is terribly injured, you want them getting care at the right place at the right time. I don't think cancer is any less complicated or important.”

Despite the measured outcome gaps among the four hospital groups, lead author Pfister said he does not interpret the findings to mean all cancer patients should flock “to some center of excellence.”

“Cancer is an emotionally difficult thing where having a supportive family is important,” Pfister said. “When they have the option to travel, they really prefer to get treated close to home."