Do cancer centers designated by the National Cancer Institute have better surgical outcomes?
BACKGROUND
The National Cancer Institute (NCI) designates cancer centers as regional centers of excellence in research and patient care. Although these centers often advertise their superior outcomes, their relative performance has not been examined empirically. In the current study, the authors assessed whether patients at NCI cancer centers compared with patients at control hospitals had lower mortality rates after major cancer surgery.


METHODS
Using the national Medicare database (1994-1999), the authors assessed surgical mortality and late survival rates for 63,860 elderly patients undergoing resection for lung, esophageal, gastric, pancreatic, bladder, or colon carcinoma. For assessing performance, patients treated at the 51 NCI cancer centers were compared with patients from 51 control hospitals with the highest volumes for each procedure. Mortality rates (surgical and 5-year rates) were adjusted for patient characteristics and residual differences in procedure volume.


RESULTS
NCI cancer centers had lower adjusted surgical mortality rates than control hospitals for 4 of the 6 procedures, including colectomy (5.4% vs. 6.7%; P = 0.026), pulmonary resection (6.3% vs. 7.9%; P = 0.010), gastrectomy (8.0% vs. 12.2%; P < 0.001), and esophagectomy (7.9% vs. 10.9%; P = 0.027). Nonsignificant trends toward lower adjusted operative mortality rates at NCI cancer centers were also observed for cystectomy and pancreatic resection. Among patients surviving surgery, however, there were no important differences in subsequent 5-year mortality rates between NCI cancer centers and control hospitals for any of the procedures.


CONCLUSIONS
For many cancer procedures, patients undergoing surgery at NCI-designated cancer centers had lower surgical mortality rates than those treated at comparably high-volume hospitals, but similar long-term survival rates.
Birkmeyer
Nancy J O
NJ
Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA. nbirkmey@umich.edu
Goodney
Philip P
PP
Stukel
Therese A
TA
Hillner
Bruce E
BE
Birkmeyer
John D
JD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D003082:Colectomy / Q000401:mortality; D015897:Comorbidity; D015653:Cystectomy / Q000401:mortality; D016629:Esophagectomy / Q000401:mortality; D005260:Female; D005743:Gastrectomy / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D016017:Odds Ratio; D010180:Pancreatectomy / Q000401:mortality; D011013:Pneumonectomy / Q000401:mortality; D013514:Surgical Procedures, Operative / Q000401:mortality*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology