National Cancer Institute Designation Predicts Improved Outcomes in Colorectal Cancer Surgery

Paulson, Emily Carter; Mitra, Nandita; Sonnad, Seema S.; Armstrong, Katrina; Wirtalla, Christopher; Kelz, Rachel R.; Mahmoud, Najjia N.

doi:10.1097/sla.0b013e318187a757

Cited by 112 publications

(108 citation statements)

References 21 publications

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“…In addition, 5-year survival of 71.5% in the non-CME group is within a close range of the data published by Kube for a German quality assurance program including 31055 patients. The SEER database reports even lower survival rates [14]. Therefore, the effect for CME surgery demonstrated here compares well to the data published so far.…”

Section: Discussionsupporting

confidence: 77%

Survival after Complete Mesocolic Excision (CME) for Right Sided Coloncancer Compared to Standard Surgery

Benz¹

2013

TOSJ

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Abstract:Purpose: Complete mesocolic excision for right sided colon cancer is a complex operation that might offer a survival benefit. However, studies comparing CME to standard surgery have not been published so far.Methods: One-hundred-seven patients were operated at the discretion of the surgeon either according to principles of complete mesocolic excision (CME-group, n=69) or received a standard right hemicolectomy (non-CME group, n=38). The type of surgery was prospectively recorded.Results: Patients in the non-CME group were significantly older (67,9 vs.78,1 p<0,001) and had fewer adjuvant chemotherapies in stage III (94,7 vs. 60,0% p=0,02). For the combined analysis of stages I-III actuarial 5-year overall-, recurrence free-and tumor specific survival was significantly better for the CME group (OS 89,4% vs. 71,5%, p=0,011; RFS 83,8% vs. 70,3% p=0,035; TSS 93,8% vs. 78,0% p=0,049). Conclusion:The data suggest a survival benefit for complete mesocolic excision in the treatment of right sided colon cancer. However, the data needs to be interpreted with caution because of the uneven distribution of age and number chemotherapies. The results of the large multicentre trial which is currently going on among German certified cancer is expected to further clarify this issue.

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Section: Discussionsupporting

confidence: 77%

Survival after Complete Mesocolic Excision (CME) for Right Sided Coloncancer Compared to Standard Surgery

Benz¹

2013

TOSJ

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“…In addition, a comprehensive center must also demonstrate professional and public education and outreach capabilities, including the dissemination of clinical and public health advances in the communities it serves.^ [2] NCIdesignated cancer centers are credited with providing multidisciplinary and state of the art cancer treatment and expertise in rare cancers [2]. Patients treated at NCI-designated cancer centers are shown to experience lower cancer surgical mortality and superior treatment outcomes [3][4][5]. However, the use of treatment services provided by NCI-designated comprehensive cancer centers (NCI-CCCs) by ethnic minority patients has not been extensively studied [6].…”

Section: Introductionmentioning

confidence: 99%

Minority Use of a National Cancer Institute-Designated Comprehensive Cancer Center and Non-specialty Hospitals in Two Florida Regions

Sultan

Gishe

Hanciles

et al. 2015

J. Racial and Ethnic Health Disparities

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Purpose To examine cancer treatment disparities at a National Cancer Institute-designated comprehensive cancer center (NCI-CCC) and non-specialty hospitals. Materials and Methods Florida hospital discharge datasets were used. ICD9-CM codes were used to define patients with female reproductive organ cancers (FROC), male reproductive organ cancers (MROC), and OTHER cancer diagnoses. A total of 7462 NCI-CCC patients and 21,875 non-specialty hospital patients were included in the statistical analysis. Data analysis was conducted in SAS 9.2.Results Increases in age reduced the odds of receiving treatment at the NCI-CCC. Male patients were more likely than female patients to be treated at the NCI-CCC. Age-adjusted odds of African American and Hispanic out/inpatients being treated at the NCI-CCC were significantly lower than those of White out/inpatients. Only patients with workers' compensation, charity, or other insurance had higher odds of being treated at the NCI-CCC. The odds of minority patients receiving outpatient treatment at the NCI-CCC declined after 2005. The odds of receiving inpatient treatment at the NCI-CCC significantly increased after 2006. Conclusions More targeted outreach by the NCI-CCC is required. However, we expect the creation of local Accountable Care Organizations (ACOs) to reduce the numbers of minority and older patients at the NCI-CCC. Coordinated quality care at ACOs implies a potential for retaining the patient market share held by non-specialty hospitals and a potential for increased demand for ACO care by minority and older patients.

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“…[4][5][6] Given the increasing regionalization of RC to high-volume, academic centres, 19 we felt it was important to validate this move by comparing outcomes at teaching and non-teaching institutions and particularly to confirm whether improved outcomes are seen at NCI-designated CC, as has already been shown for other major oncologic surgery. 11,12 Our analysis raised several noteworthy findings. Firstly, to our knowledge, we are the first to demonstrate superior perioperative outcomes after RC at centres with NCI designation.…”

Section: Discussionmentioning

confidence: 80%

“…10 However, there are only a few reports comparing postoperative outcomes after major oncologic surgery between NCI-designated CC and those without such designation. 11,12 These studies analyzed historic cohorts of patients treated in the previous decade and found that postoperative mortality rates after visceral 11,12 and thoracic surgery were lower in NCI-designated CC. 11,12 Importantly, no difference in operative mortality was seen for RC, 11 and in any case, perioperative outcomes were not assessed as the primary endpoint in either study.…”

Section: Introductionmentioning

confidence: 99%

Perioperative outcomes after radical cystectomy at NCI-designated centres: Are they any better?

Roghmann

Ravi

Hanske

et al. 2015

CUAJ

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Introduction: In 1971, the National Cancer Institute (NCI) introduced a network of NCI-designated Cancer Centers (CC), which underwent a comprehensive approval process relying on research, education and prevention activities. In this study, we examine the effect of CC status on perioperative outcomes after radical cystectomy (RC). Methods: Within the Nationwide Inpatient Sample, we focused on RC performed from 2006 to 2010. As all recognized centres were residency teaching institutions, we stratified according to teaching and CC-teaching status. We examined the rates of in-hospital mortality, intra-and postoperative complications, prolonged length of hospital stay, as well as blood transfusion. Multivariable logistic regression analyses were further adjusted for confounding factors. Results: Overall, 22 840 RC patients (5451 at non-teaching, 10 857 at residency teaching, 6532 at CC-teaching institutions) were identified. Patients treated at residency teaching and CC-teaching institutions were younger, had less comorbidities, and more likely to have private insurance. In multivariable analyses, patients treated at residency and CC-teaching institutions were less likely to experience postoperative complications (odds ratio [OR] 0.73 and 0.66, respectively) and blood transfusions (OR 0.77 and 0.53, respectively) relative to patients treated at non-teaching institutions. In addition, CC patients were also less likely to experience in-hospital mortality (OR 0.61, all p < 0.001) as compared to non-teaching institutions. Conclusions: On average, patients treated at residency and CC-teaching institutions are less likely to experience unfavourable outcomes after RC. Moreover, patients treated at CC fared better than patients treated at residency teaching institutions. Our findings acknowledge the quality of RC care at accredited centres.

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National Cancer Institute Designation Predicts Improved Outcomes in Colorectal Cancer Surgery

Cited by 112 publications

References 21 publications

Survival after Complete Mesocolic Excision (CME) for Right Sided Coloncancer Compared to Standard Surgery

Survival after Complete Mesocolic Excision (CME) for Right Sided Coloncancer Compared to Standard Surgery

Minority Use of a National Cancer Institute-Designated Comprehensive Cancer Center and Non-specialty Hospitals in Two Florida Regions

Perioperative outcomes after radical cystectomy at NCI-designated centres: Are they any better?

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