Where to Go for Cancer Care—A Shot in the Dark

[Hopeful]

As Reported by Newsweek. 2009 Oct 26

America has some of the best cancer care in the world, but not everyone knows how to find it. Even more difficult is finding out a cancer center’s track record in treating a specific type of cancer. Are the outcomes that much better to justify the expense and effort of travelling to a top cancer hospital for treatment? An article in the October 26 issue of Newsweek took a close look at the subject of the disparity in cancer care in America. In doing their research, the authors interviewed oncologists, studied journal articles, and analyzed outcomes data from varying institutions, ranging from elite centers to community-based hospitals. They found that there can, indeed, be significant differences in outcomes depending on where a person is treated. This is especially true if the cancer is neither so rare that specialized care is obviously required, nor so straightforward that standardized care will suffice. Death rates are, in fact, lower at leading hospitals. And it’s not just technology that makes the difference. The most important factors are experience, a correct diagnosis, testing for molecular markers, and patient follow-up. A knowledge gap at a community hospital can adversely affect patient outcomes.

Even among the elite cancer centers, outcomes vary. Differences in a surgeon’s skill, or better management of treatment side effects, can influence results.

The general public will find it difficult to obtain the relevant statistics, however. Cancer centers guard these like state secrets. Finding the best place to go for cancer treatment is often a hit-or-miss process. A tip from a neighbor or a local practitioner may be all that some people have to go on.
Cancers requiring complex surgeries or treatments are most vulnerable to the disparities in quality between the care delivered at a cancer center and that available within the local community. Patients with such cancers fare better if treated at hospitals affiliated with the National Comprehensive Cancer Network. Surgeons may be more experienced there, and complication rates tend to be lower at elite hospitals.

Common cancers, such as breast, prostate, and colon tumors, can often be treated adequately at local hospitals, however. Five-year survival rates for common cancers are roughly equivalent whether the cancers were treated at a top academic center or at a local hospital. Postoperative chemotherapy or radiation therapy is often so well described by standardized protocols that it can be administered at the local level.

The disparity between elite hospitals and community hospitals is most evident with regard to the accuracy of the diagnosis, which is at the crux of successful cancer treatment. From 5% to 10% of all patients referred to the MD Anderson Cancer Center end up with a different diagnosis and often a different treatment plan.

Top cancer centers also coordinate care better than do local hospitals. Reducing the delay between testing and the beginning of treatment can spell the difference between life and death when dealing with aggressive cancers. Top cancer centers are also more willing to try every possible treatment. The concentration of experts working on each patient case brings a wealth of experience and knowledge to the case. Better management of side effects preserves both quality of life and the ability of the patient to persist with treatment.

In an effort to extend the expertise of cancer centers to the local level, the National Cancer Institute has initiated the Community Cancer Centers Program. This may help raise the level of care in various regions of the country and make getting good care less of a shot in the dark.

Hopeful