Are You Getting the Best Possible Care?

PJ Hamel Health Guide January 12, 2010
  • You find a lump in your breast. You report it to your doctor, and a mammogram becomes an MRI, then a biopsy, then a diagnosis: breast cancer.

    What’s your next move?

    You do what your doctor tells you. You set up appointments at your local hospital with a surgeon to remove the tumor, and an oncologist to direct your treatment. You plunge in: surgery, chemo, radiation, drugs.

    Treatment finished, you live happily ever after. Right?

    Maybe. But maybe not. And the difference might be where you get your treatment.

    Fifty-eight cancer centers and hospitals around the country have earned National Cancer Institute designation as top facilities for treating cancer. These hospitals meet and maintain very high standards in “research, excellence in patient care, training and education, demonstration of technologies, and cancer control,” according to the NCI Web site.


    And do these top cancer centers come through where it counts – in saving patients’ lives?

    Apparently, they do. Several recent studies have shown that NCI Cancer Centers offer patients demonstrably better survival rates than community hospitals. A recent Dartmouth Medical School study, involving lung, breast, colon, and prostate cancer, showed that nationally, mortality rates for patients receiving care at NCI Cancer Centers were 25% lower, after 1 year, than for those treated at community hospitals.

    And this was true for all stages of cancer. In fact, there was an even greater disparity between NCI hospitals and community hospitals for patients with later-stage cancer, or those with other health problems, such as diabetes or congestive heart failure.

    NCI hospitals save more patient lives. But why? Is it more money for better equipment, cutting edge drugs…? What’s the difference?

    Surprisingly, it’s not the most up-to-date equipment or drugs that make the difference. An article last fall in “Newsweek” magazine  (“What You Don’t Know Might Kill You” – October 26, 2009), offers the following possible reasons:

    •Patient volume. The more patients treated, the more data, the more guidance physicians have in directing treatment.

    •The number of available specialists, and their level of knowledge and experience. NCI hospitals tend to attract the nation’s best oncologists, and oncological surgeons and radiologists. These doctors have treated many cancer patients (see “patient volume,” above); they have access to the latest research (one of the standards NCI hospitals must meet is excellence in research); and they can call on one another for second opinions.

    For example, a community hospital might have one or two oncologists, total. The Fred Hutchinson Cancer Research Center in Seattle, part of the NCI network, has 24 oncologists in the breast program alone.

    •NCI centers are better at making the initial diagnosis. Patients receiving a second opinion at an NCI center, after having first been diagnosed at a community hospital, are often found to have more extensive cancer, or a different sub-type. NCI centers also tend to identify cancer where none was found in patients whose first contact was at a community hospital.


  • Dartmouth researchers add that a high rate of adherence to NCI treatment guidelines; and a multidisciplinary approach, where surgeons and oncologists and radiation oncologists work together closely to achieve the best outcomes, may be key to more effective treatment at NCI centers.


    So what’s a woman with breast cancer to do? We can’t all access NCI Cancer Centers. About 90% of cancer patients nationwide are treated in community hospital settings, or by oncologists in private practice.

    The good news is, breast cancer is one of the more common cancers, and is widely understood by most oncologists. The vast majority of breast cancer patients (as opposed to those with a rarer type of cancer) can be successfully treated at community hospitals. Chemo and radiation are pretty standard, wherever you get them.

    But if you have a more unusual type of breast cancer – say, inflammatory breast cancer, or Paget’s disease – you might consider traveling to an NCI Cancer Center to develop your treatment plan, which can then hopefully be implemented closer to home.

    And even if you have a straightforward IDC diagnosis, you might consider a second opinion at an NCI Cancer Center – especially if your oncologist seems at all “iffy” about your treatment plan. (Or if you feel a bit “iffy” about your oncologist.)

    There are 65 NCI Cancer Centers spread across 34 states; 58 of these centers provide patient care, while seven are devoted solely to research. If one is within driving reach – why not?

    Even if you’re far removed from an NCI Cancer Center, help is on the way. The NCI Community Cancer Centers Program is a 3-year pilot program designed to bring state-of-the-art cancer care to patients in community hospitals across the United States. It’s currently being launched at 16 community hospitals scattered around the country, from Hartford, Connecticut; to Sioux Falls, South Dakota, to Orange, California.

    Top-notch cancer care, coming soon to a hospital near you? Maybe. Here’s a list of the 16 hospitals participating in the NCI’s pilot program. And here’s a list of NCI Cancer Centers. You may already be closer than you think to the best cancer care possible.