Cancer Mortality: Does Where You Get Your Treatment Matter?

Being a long-tenured oncology nurse who has resided in numerous cities over the years, I have frequently been asked for advice by family, friends, and colleagues who the “best oncologist” and the “best hospital” is in my locale. Historically, those of you who have been in similar shoes like mine responded to this query based on our professional experiences and knowledge of practice standards within our community. This was my case decades ago when my father was initially diagnosed with early-stage lung cancer and required surgery. I immediately sought advice from expert nurse and physician colleagues who worked in the city where he was to receive treatment.

Decisions on the receipt of contemporary cancer care, however, do not solely rely on opinion and word of mouth. In today’s healthcare environment, an evolving and increasing dataset of quality metrics is available to augment decision-making about the “where” and “by whom” cancer care is optimally delivered. Case in point were the results of a recent investigation evaluating mortality in Medicare beneficiaries treated in leading cancer hospitals and their network partners.¹

Older patients (>65 years) having undergone complex cancer surgery (i.e., lobectomy, esophagectomy, gastrectomy, colectomy, pancreaticoduodenectomy [Whipple procedure]) comprised the sample. Ninety-day perioperative mortality was the outcome measure. Two groups were compared. Group 1 included 17,300 older patients who underwent complex surgery at 59 top-ranked cancer hospitals. Group 2 included 11,928 older patients who underwent comparable procedures in 343 network-affiliated hospitals which represented a total of 49 networks. It was determined that surgery performed at affiliated hospitals was associated with a higher 90-day mortality rate. When hospital attributes were added to adjusted hierarchical regression analyses, surgical case volume and institutional teaching status influenced the magnitude and significance of the differential.

These findings enhance oncology nurses’ understanding of current treatment deliberations specific to surgical oncology. Probably most important is that the results challenged an assumed equivalence in cancer care based on affiliation status. With improved treatment outcomes being quantified in the top-ranked cancer hospitals, the researchers posited that perhaps the more complex, high-risk surgeries should be triaged to these sites. Greater experience relative to higher case volumes and the availability of specialty physicians and nurses may be associated with these findings. The second implication of this research was the need to share best practices and novel surgical techniques with network affiliation facility staff.

Surgical oncology nurses practicing within top-ranked cancer hospitals have numerous opportunities to share their expertise. This includes critical thinking (especially in the early recognition of negative patient sequelae), optimum management of wounds inclusive of dressings and other products, infection prevention (especially pulmonary interventions), and approaches to enhance early mobility (including ideal post-surgical pain management with the integration of physical therapists’ expertise).

Increased public access to quality metrics requires everyone on the specialty cancer care team to maintain a state of hyper-vigilance in reviewing outcome measures, sharing information about new approaches, and collaborating on the development of novel strategies to improve quality.

Reference:

• Hoag JR, Resio BJ, Monsalve AF et.al. Differential safety between top-ranked cancer hospitals and their affiliates for complex cancer surgery. JAMA Network Open, 2019. 2(4): e191912. Doi: 10.1001/jamanetworkopen.2019.1912.