Survival as Quality Metric in Cancer Care

Key Points

  • Few hospitals had significantly better or worse risk-adjusted survival compared with other hospitals.
  • NCI-designated cancer centers were associated with the best risk-adjusted survival.

In a National Cancer Data Base study reported in the Journal of Oncology Practice, Shulman et al found little difference in risk-adjusted cancer mortality rates among individual hospitals, suggesting survival may not be an ideal quality metric at the individual hospital level. However, survival was better among National Cancer Institute (NCI)-designated comprehensive cancer centers compared with academic and community hospitals.

Study Details

The study included an analysis of risk-adjusted hazards for survival among patients with stage III breast cancer (n = 116,787) and stage IIIB or IV non–small cell lung cancer (n = 252,392) at 1,593 hospitals included in the National Cancer Data Base.

Findings Among Individual Hospitals and by Hospital Type

Among the 1,593 hospitals, risk-adjusted hazard ratios for survival were statistically better for 8 and statistically worse for 6 for breast cancer patients and statistically better for 15 and statistically worse for 5 for lung cancer patients.

Compared with academic hospitals, risk-adjusted survival for breast cancer patients was significantly better for NCI-designated comprehensive cancer centers (hazard ratio [HR] = 0.88, 95% confidence interval [CI] = 0.81–0.95) and significantly worse for comprehensive community hospitals (HR = 1.09, 95% CI = 1.04–1.14) and community hospitals (HR = 1.17, 95% CI = 1.11–1.23). Similarly, compared with academic hospitals, risk-adjusted survival for lung cancer patients was significantly better for NCI-designated comprehensive cancer centers (HR = 0.83, 95% confidence interval [CI] = 0.80–0.86) and significantly worse for comprehensive community hospitals (HR = 1.07, 95% CI = 1.05–1.09) and community hospitals (HR = 1.14, 95% CI = 1.11–1.17).

The investigators concluded: “Using the [National Cancer Data Base] as the data source, survival rates for patients with stage III breast cancer and stage IIIB or IV non–small-cell lung cancer were statistically better at National Cancer Institute–designated comprehensive cancer centers when compared with other hospital types. Compared with academic hospitals, risk-adjusted survival was lower in community hospitals. At the individual hospital level, after risk adjustment, few hospitals were shown to have statistically better or worse survival, suggesting that, using [National Cancer Data Base] data, survival may not be a good metric to determine relative quality of cancer care at this level.”

Lawrence N. Shulman, MD, of the Abramson Cancer Center, University of Pennsylvania, is the corresponding author of the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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