• Funniest Story on the Job Contest Starts Now!

    Contest starts now and ends September 27th. Winner will receive a special user banner and $10 Amazon Gift card!

    JOIN NOW
  • Site Updates Coming Next Week

    Site updates are coming next week on Monday and Friday. Click the button below to learn more!

    LEARN MORE

So changing the sign on your center doesn't improve outcomes?

GI_RadOnc

Full Member
Nov 7, 2019
75
218
66
  1. Academic Administration
I tend to hate NCDB analyses; because often the questions asked aren't appropriate for the data available; but I think this is a very interesting one looking at top ranked (US News and World Report) cancer hospitals; and their 'affiliates.' Many of us know that these affiliates may be little more than a change of sign on the center!


" These findings suggest that short- and long-term survival after complex cancer treatment were superior at top-ranked hospitals compared with affiliates of top-ranked hospitals. Further study of cancer care within top-ranked cancer networks could reveal collaborative opportunities to improve survival across a broad contingent of the US population. "


Boffa DJ, Mallin K, Herrin J, et al. Survival After Cancer Treatment at Top-Ranked US Cancer Hospitals vs Affiliates of Top-Ranked Cancer Hospitals. JAMA Netw Open. 2020;3(5):e203942. doi:10.1001/jamanetworkopen.2020.3942
 
  • Like
  • Haha
Reactions: 3 users

RickyScott

Full Member
2+ Year Member
Oct 4, 2017
2,542
4,371
126
  1. Attending Physician
Pts traveling to the main center are inherently better pts. Back in early 2000s (prior to hpv data) U of Chicago had study that pts who drove 25 miles to main center for head and neck radiation did much better (guess why?) pts flying to Cleveland clinic and mayo for heart surgery probably do much better than average gomer in community hospital. Absolute garbage research.
 
  • Like
  • Haha
Reactions: 9 users

BobbyHeenan

Full Member
7+ Year Member
Mar 20, 2013
1,114
1,527
226
  1. Attending Physician
I think care at top ranked hospitals is probably better. I also think the sign doesn't help outcomes either.

However, as one of my good MD Anderson trained surg onc buddy likes to say when talking about some of our common rural, poor patients..."this guy ain't the kind that flies into Houston for his consults."

Not to derail, but....

I would love to see a study of outcomes at MDA that has zip codes in there for outcomes. If you had the money, support, and KPS to get to Houston from across your country you're already ahead of the game. I wonder if the out-of-towners do better? However, sometimes if they get complications then may be hard to manage from out of town. Hard to know.

I was reading about some places multi disciplinary head and neck dental clinic and custom mouth guards they're making for radiation and I'm over here either begging an oral surgeon in community to do some free extractions or seeing if the health dept can do some on my folks that haven't seen a dentist in 30 years....or just throwing my hands up and starting treatment because their tumor grows as we puts around with "dental clearance." no way in hell I'm getting some custom molded device to shift their tongue around when they can hardly afford food.
 
  • Like
Reactions: 5 users
About the Ads

BobbyHeenan

Full Member
7+ Year Member
Mar 20, 2013
1,114
1,527
226
  1. Attending Physician
this kind of work is bs. Pts traveling to the main center are inherently better pts. Back in early 2000s Chicago had study that pts who drove 25 miles to main center for head and neck cancer did much better (guess why?) pts flying to Cleveland clinic and mayo for heart surgery probably do much better than average gomer in community hospital. Absolute garbage research


Ha - we posted the same sentiment seconds apart.
 

RickyScott

Full Member
2+ Year Member
Oct 4, 2017
2,542
4,371
126
  1. Attending Physician
Just finished Vinay prasads malignant which I can’t recommend enough. He mentions study from Harvard where they observed that pts eating a certain amount of expensive nuts per day with stage 4 colon cancer had a bigger absolute survival gain than comes from chemo. Ties in with the theme that richer healthier pts who are able to travel not surprisingly do better.
Infinite permutations to getting crap research out of this effect that better pts do in fact do better- maybe price of car/country club membership, premium Cadillac medical Insurance policy, personal nurse etc all ideas for silly abstract?
 
Last edited:
  • Like
Reactions: 1 user

OTN

Member
15+ Year Member
Nov 6, 2003
1,474
3,307
326
I think care at top ranked hospitals is probably better. I also think the sign doesn't help outcomes either.

However, as one of my good MD Anderson trained surg onc buddy likes to say when talking about some of our common rural, poor patients..."this guy ain't the kind that flies into Houston for his consults."

Not to derail, but....

I would love to see a study of outcomes at MDA that has zip codes in there for outcomes. If you had the money, support, and KPS to get to Houston from across your country you're already ahead of the game. I wonder if the out-of-towners do better? However, sometimes if they get complications then may be hard to manage from out of town. Hard to know.

I was reading about some places multi disciplinary head and neck dental clinic and custom mouth guards they're making for radiation and I'm over here either begging an oral surgeon in community to do some free extractions or seeing if the health dept can do some on my folks that haven't seen a dentist in 30 years....or just throwing my hands up and starting treatment because their tumor grows as we puts around with "dental clearance." no way in hell I'm getting some custom molded device to shift their tongue around when they can hardly afford food.

Strongly disagree that care at top-ranked hospitals is uniformly better. Very dependent on comparative practices.

Patient population (at least in our neck of the woods) at the community centers is much sicker and poorer than that at the academically-affiliated tertiary care center, who does not take patients without insurance. "Not in our mission to do so."
 
  • Like
Reactions: 4 users

BobbyHeenan

Full Member
7+ Year Member
Mar 20, 2013
1,114
1,527
226
  1. Attending Physician
Strongly disagree that care at top-ranked hospitals is uniformly better. Very dependent on comparative practices.

Patient population (at least in our neck of the woods) at the community centers is much sicker and poorer than that at the academically-affiliated tertiary care center, who does not take patients without insurance. "Not in our mission to do so."

I think it's a probably regional thing. Like everything there are good and bad actors out there. I've had denials from my regional academic center on some patients due to insurance issues and it was a shocker to me - we never denied anyone where I trained.

I think your take is reasonable (ie care isn’t uniformly better).

Definitely agree that in some patches out there, the local community centers are seeing sicker patients with less resources.
 
Last edited:
  • Like
Reactions: 1 user

Chartreuse Wombat

Full Member
7+ Year Member
May 7, 2014
1,176
2,149
226
  1. Attending Physician
I tend to hate NCDB analyses; because often the questions asked aren't appropriate for the data available; but I think this is a very interesting one looking at top ranked (US News and World Report) cancer hospitals; and their 'affiliates.' Many of us know that these affiliates may be little more than a change of sign on the center!


" These findings suggest that short- and long-term survival after complex cancer treatment were superior at top-ranked hospitals compared with affiliates of top-ranked hospitals. Further study of cancer care within top-ranked cancer networks could reveal collaborative opportunities to improve survival across a broad contingent of the US population. "


Boffa DJ, Mallin K, Herrin J, et al. Survival After Cancer Treatment at Top-Ranked US Cancer Hospitals vs Affiliates of Top-Ranked Cancer Hospitals. JAMA Netw Open. 2020;3(5):e203942. doi:10.1001/jamanetworkopen.2020.3942
This includes only surgical patients; BIG extrapolation to other cancer disciplines. BTW there is a well established relationship between quality and volume especially for risky surgical procedures (Whipple, esophagectomy, etc). It doesn't look like they controlled for operator volume. WOuldn't this confound any results?
 
  • Like
Reactions: 4 users

evilbooyaa

Full Member
Staff member
Volunteer Staff
7+ Year Member
Oct 10, 2011
7,243
7,795
326
  1. Attending Physician
This includes only surgical patients; BIG extrapolation to other cancer disciplines. BTW there is a well established relationship between quality and volume especially for risky surgical procedures (Whipple, esophagectomy, etc). It doesn't look like they controlled for operator volume. WOuldn't this confound any results?

Agreed. Much easier to QA bad radiation oncology with good virtual chart rounds than bad surgery. Still not easy, but at least easier.
 
About the Ads
This thread is more than 1 year old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.