So changing the sign on your center doesn't improve outcomes?

[GI_RadOnc]

I tend to hate NCDB analyses; because often the questions asked aren't appropriate for the data available; but I think this is a very interesting one looking at top ranked (US News and World Report) cancer hospitals; and their 'affiliates.' Many of us know that these affiliates may be little more than a change of sign on the center!

Survival After Cancer Treatment at Top-Ranked US Cancer Hospitals vs Affiliates of Top-Ranked Cancer Hospitals - PubMed

These findings suggest that short- and long-term survival after complex cancer treatment were superior at top-ranked hospitals compared with affiliates of top-ranked hospitals. Further study of cancer care within top-ranked cancer networks could reveal collaborative opportunities to improve...

pubmed.ncbi.nlm.nih.gov

" These findings suggest that short- and long-term survival after complex cancer treatment were superior at top-ranked hospitals compared with affiliates of top-ranked hospitals. Further study of cancer care within top-ranked cancer networks could reveal collaborative opportunities to improve survival across a broad contingent of the US population. "


Boffa DJ, Mallin K, Herrin J, et al. Survival After Cancer Treatment at Top-Ranked US Cancer Hospitals vs Affiliates of Top-Ranked Cancer Hospitals. JAMA Netw Open. 2020;3(5):e203942. doi:10.1001/jamanetworkopen.2020.3942

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[RickyScott]

Pts traveling to the main center are inherently better pts. Back in early 2000s (prior to hpv data) U of Chicago had study that pts who drove 25 miles to main center for head and neck radiation did much better (guess why?) pts flying to Cleveland clinic and mayo for heart surgery probably do much better than average gomer in community hospital. Absolute garbage research.

 

[BobbyHeenan]

I think care at top ranked hospitals is probably better. I also think the sign doesn't help outcomes either.

However, as one of my good MD Anderson trained surg onc buddy likes to say when talking about some of our common rural, poor patients..."this guy ain't the kind that flies into Houston for his consults."

Not to derail, but....

I would love to see a study of outcomes at MDA that has zip codes in there for outcomes. If you had the money, support, and KPS to get to Houston from across your country you're already ahead of the game. I wonder if the out-of-towners do better? However, sometimes if they get complications then may be hard to manage from out of town. Hard to know.

I was reading about some places multi disciplinary head and neck dental clinic and custom mouth guards they're making for radiation and I'm over here either begging an oral surgeon in community to do some free extractions or seeing if the health dept can do some on my folks that haven't seen a dentist in 30 years....or just throwing my hands up and starting treatment because their tumor grows as we puts around with "dental clearance." no way in hell I'm getting some custom molded device to shift their tongue around when they can hardly afford food.

 

[BobbyHeenan]

this kind of work is bs. Pts traveling to the main center are inherently better pts. Back in early 2000s Chicago had study that pts who drove 25 miles to main center for head and neck cancer did much better (guess why?) pts flying to Cleveland clinic and mayo for heart surgery probably do much better than average gomer in community hospital. Absolute garbage research

Ha - we posted the same sentiment seconds apart.

 

[RickyScott]

Just finished Vinay prasads malignant which I can’t recommend enough. He mentions study from Harvard where they observed that pts eating a certain amount of expensive nuts per day with stage 4 colon cancer had a bigger absolute survival gain than comes from chemo. Ties in with the theme that richer healthier pts who are able to travel not surprisingly do better.
Infinite permutations to getting crap research out of this effect that better pts do in fact do better- maybe price of car/country club membership, premium Cadillac medical Insurance policy, personal nurse etc all ideas for silly abstract?

 

[OTN]

I think care at top ranked hospitals is probably better. I also think the sign doesn't help outcomes either.

However, as one of my good MD Anderson trained surg onc buddy likes to say when talking about some of our common rural, poor patients..."this guy ain't the kind that flies into Houston for his consults."

Not to derail, but....

I would love to see a study of outcomes at MDA that has zip codes in there for outcomes. If you had the money, support, and KPS to get to Houston from across your country you're already ahead of the game. I wonder if the out-of-towners do better? However, sometimes if they get complications then may be hard to manage from out of town. Hard to know.

I was reading about some places multi disciplinary head and neck dental clinic and custom mouth guards they're making for radiation and I'm over here either begging an oral surgeon in community to do some free extractions or seeing if the health dept can do some on my folks that haven't seen a dentist in 30 years....or just throwing my hands up and starting treatment because their tumor grows as we puts around with "dental clearance." no way in hell I'm getting some custom molded device to shift their tongue around when they can hardly afford food.

Strongly disagree that care at top-ranked hospitals is uniformly better. Very dependent on comparative practices.

Patient population (at least in our neck of the woods) at the community centers is much sicker and poorer than that at the academically-affiliated tertiary care center, who does not take patients without insurance. "Not in our mission to do so."

 

[BobbyHeenan]

Strongly disagree that care at top-ranked hospitals is uniformly better. Very dependent on comparative practices.

Patient population (at least in our neck of the woods) at the community centers is much sicker and poorer than that at the academically-affiliated tertiary care center, who does not take patients without insurance. "Not in our mission to do so."

I think it's a probably regional thing. Like everything there are good and bad actors out there. I've had denials from my regional academic center on some patients due to insurance issues and it was a shocker to me - we never denied anyone where I trained.

I think your take is reasonable (ie care isn’t uniformly better).

Definitely agree that in some patches out there, the local community centers are seeing sicker patients with less resources.

 

[Chartreuse Wombat]

I tend to hate NCDB analyses; because often the questions asked aren't appropriate for the data available; but I think this is a very interesting one looking at top ranked (US News and World Report) cancer hospitals; and their 'affiliates.' Many of us know that these affiliates may be little more than a change of sign on the center!

Survival After Cancer Treatment at Top-Ranked US Cancer Hospitals vs Affiliates of Top-Ranked Cancer Hospitals - PubMed

These findings suggest that short- and long-term survival after complex cancer treatment were superior at top-ranked hospitals compared with affiliates of top-ranked hospitals. Further study of cancer care within top-ranked cancer networks could reveal collaborative opportunities to improve...

pubmed.ncbi.nlm.nih.gov

" These findings suggest that short- and long-term survival after complex cancer treatment were superior at top-ranked hospitals compared with affiliates of top-ranked hospitals. Further study of cancer care within top-ranked cancer networks could reveal collaborative opportunities to improve survival across a broad contingent of the US population. "


Boffa DJ, Mallin K, Herrin J, et al. Survival After Cancer Treatment at Top-Ranked US Cancer Hospitals vs Affiliates of Top-Ranked Cancer Hospitals. JAMA Netw Open. 2020;3(5):e203942. doi:10.1001/jamanetworkopen.2020.3942

This includes only surgical patients; BIG extrapolation to other cancer disciplines. BTW there is a well established relationship between quality and volume especially for risky surgical procedures (Whipple, esophagectomy, etc). It doesn't look like they controlled for operator volume. WOuldn't this confound any results?

 

[evilbooyaa]

This includes only surgical patients; BIG extrapolation to other cancer disciplines. BTW there is a well established relationship between quality and volume especially for risky surgical procedures (Whipple, esophagectomy, etc). It doesn't look like they controlled for operator volume. WOuldn't this confound any results?

Agreed. Much easier to QA bad radiation oncology with good virtual chart rounds than bad surgery. Still not easy, but at least easier.