title: Comparison of commission on cancer-approved and -nonapproved hospitals in the United States: implications for studies that use the National Cancer Data Base.
abstract: BACKGROUND
  The Commission on Cancer (CoC) designates cancer programs on the basis of the ability to provide a wide range of oncologic services and specialists. All CoC-approved hospitals are required to report their cancer diagnoses to the National Cancer Data Base (NCDB), and the cancer diagnoses at these hospitals account for approximately 70% of all new cancers diagnosed in the United States annually. However, it is unknown how CoC-approved programs compare with non-CoC-approved hospitals.
  
  
  METHODS
  By using the American Hospital Association Annual Survey Database (2006), CoC-approved and non-CoC-approved hospitals were compared with respect to structural characteristics (ie, accreditations, geography, and oncologic services provided).
  
  
  RESULTS
  Of the 4,850 hospitals identified, 1,412 (29%) were CoC-approved hospitals, and 3,438 (71%) were not CoC-approved hospitals. The proportion of CoC-approved hospitals varied at the state level from 0% in Wyoming to 100% in Delaware. Compared with non-CoC-approved hospitals, CoC-approved programs were more frequently accredited by the Joint Commission, designated as a Comprehensive Cancer Center by the National Cancer Institute, and affiliated with a medical school or residency program (P < .001). CoC-approved hospitals were less likely to be critical access hospitals or located in rural areas (P < .001). CoC-approved hospitals had more total beds and performed more operations per year (P < .001). CoC-approved programs more frequently offered oncology-related services, including screening programs, chemotherapy and radiation therapy services, and hospice/palliative care (P < .001).
  
  
  CONCLUSIONS
  Compared with non-CoC-approved hospitals, CoC-approved hospitals were larger, were more frequently located in urban locations, and had more cancer-related services available to patients. Studies that use the NCDB should acknowledge this limitation when relevant.
authors.affiliation: American College of Surgeons, Division of Research and Optimal Patient Care, 636 N St Clair St, Chicago, IL 60611, USA. kbilimoria@facs.org
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Stewart
authors.forename: David P
authors.initials: DP
authors.lastname: Winchester
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
mesh_terms: D019992:Databases as Topic / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research / Q000592:standards / Q000706:statistics & numerical data*; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D054547:National Cancer Institute (U.S.) / Q000592:standards / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology