What are the very best hospitals for cancer care in America doing that is “better”?

According to a new article in JAMA Oncology, just published on line yesterday, we may be able to better define which really are “the best” hospitals in America at which cancer care (prostate cancer care specifically included) is being given today.

This new paper by Pfister and his colleagues at Memorial Sloan-Kettering Cancer Center (MSKCC) indicates that a small group of specialized hospitals that are exempt from the Medicare prospective payment system (PPS) had better outcomes than all others at 3 and 5 years for four major types of cancer — lung, prostate, breast, and colon — and for an “other cancer” category. The full text of the paper by Pfister et al. is available on line, as is a discussion of the paper’s key findings in “layman’s language” on the MSKCC web site.

The study encompassed data from > 5,100 U.S. hospitals, and here are the overall 5-year cancer survival data (including all types of cancer) by category of hospital:

  • 53 percent for a select group of 11 PPS-exempt specialized cancer institutions
  • 49 percent for a subset of 32 specialized cancer institutions, all accredited by the National Cancer Institute, that are members of the National Comprehensive Cancer Network but which are not PPS exempt
  • 46 percent for another set of 252 academic medical centers
  • 44 percent for the remaining 4,873 hospitals (inclusive of community hospitals)

Now in understanding these data it is extremely important to appreciate two key points:

  • They do not in any way imply that no community hospitals in America are able to provide the very highest quality of cancer care.
  • The primary value of the data from this study will be in starting to use them to work out how to raise the overall quality of cancer care by determining what the hospitals with the best outcomes are doing that others aren’t doing, and then ensuring that we apply the same processes in every hospital to the greatest extent possible (thus “closing the quality gap”).

From a prostate cancer-specific point of view (as shown in Figure 1 in the full text of the paper), of the four specific types of cancer evaluated in this study, prostate cancer patients were the largest single group:

  • Total number of patients included in the study: 729,279
  • Number of prostate cancer patients included: 183,881 (25.2 percent)
  • Number of lung/bronchus cancer patients included: 92,454 (12.7 percent)
  • Number of breast cancer patients included: 72,299 (9.9 percent)
  • Number of colorectal cancer patients included: 68,480 (9.4 percent)
  • Number of “other” cancer patients included: 312,165 (42.8 percent)

Clearly, prostate cancer patients were a highly represented subset of the patients included in the study.

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