New research published in JNCCN—Journal of the National Comprehensive Cancer Network assessed the quality of cancer care delivered through extended sites coordinated by some of the country’s largest cancer centers. The study was developed to implement strategies for disseminating discoveries and expanding access to the highest-quality cancer care as part of Association of American Cancer Institutes’ (AACI) Network Care Initiative, established by former AACI President Stanton L. Gerson, MD, first author of the study.
Stanton L. Gerson, MD
Study Methodology
The AACI Network Care Initiative Steering Committee, composed of cancer center directors and chief medical officers, designed a survey that was then distributed to each cancer center’s director and chief administrative director.
For the purposes of the study, main cancer centers were defined as a tertiary care center, also known as the flagship treatment and research facility (inpatient and outpatient), where state-of-the-art clinical services are provided (off-site, hospital-linked disease program facilities would be considered part of the main cancer center if owned and operated as one unit). Network practice sites were defined as multiple physician practice sites providing clinical inpatient or outpatient care (network sites may or may not have shared the cancer center, medical center, or university’s branding and could be located within the United States or abroad).
Results were calculated based on responses to the mixed-methods survey answered by 69 cancer centers between September 2017 and December 2018, at which time 56 reported at least one network practice site.
Just over half indicated that network sites had full access to the main centers’ electronic medical records (EMRs)—and even fewer main centers had complete access to records throughout their network sites.
“Our findings demonstrate the need to improve network site alignment, particularly in patient navigators, care paths, and clinical trial access,” said Dr. Gerson, Director of the Case Comprehensive Cancer Center and Interim Dean of the Case Western Reserve University School of Medicine. “Most federal cancer center reviews do not assess the total population of…patients served by major cancer centers and their affiliated sites. These data suggest that a very sizable portion of new cancer cases are cared for by these centers and their networks. Greater cancer center/network coordination could ultimately lead to improved access to clinical trials for the underrepresented communities many of these network sites serve.”
Improving Care
According to the survey results, some key opportunities to improve coordination of care include:
- Implementing integrated EMRs across networks
- Reviewing best clinical care practices, with more rigorous use of care paths and coordination of diagnosis and treatment planning across sites
- Greater attention and support for cancer clinical trials across network sites
- Improved physician oversight of clinical and research expectations, hiring, review, and other links with cancer center main campus sites.
“Many studies show that consistency through care plans and guidelines improves patient outcomes, clinical response, and survival. More proactive approaches, including care paths, tumor boards across networks, and recognition of the value of placing disease experts at network sites will improve the standardization of care across sites,” Dr. Gerson added.
Commentary
“Disparities in cancer care outcomes—most significantly, patient survival—have been shown between National Cancer Institute–designated cancer centers and community hospitals, where two-thirds of patients [with cancer] are cared for in the United States,” commented Lawrence N. Shulman, MD, Deputy Director for Clinical Services at the Abramson Cancer Center at the University of Pennsylvania, who was not involved in this research.
Lawrence N. Shulman, MD
“Rural cancer programs often have limited cancer physicians representing all relevant specialties, and urban safety-net hospitals often have limited financial resources to support high-quality cancer programs. Partnerships between academic cancer centers and community and safety-net hospitals have the potential to improve outcomes for a broader spectrum of patients in the United States. One might consider support of these cancer programs an obligation of academic cancer centers. This study outlines some potential mechanisms of support,” he added.
The COVID-19 pandemic, which began well after this survey closed, and the growing call for increasing diversity in clinical trials are also driving the need to better integrate network sites as a tool for delivering quality care to underserved populations.
Disclosure: For full disclosures of the study authors, visit jnccn.org.
