How to Choose a Hospital for Cancer Treatment

photo of older woman leaning against older man - choose a hospital for cancer treatmentHearing a cancer diagnosis is one of the scariest moments you can experience. I know. It happened to us in 2005 when our teenage son was diagnosed with a terminal brain tumor. Everyone with cancer wants the best chance for a good outcome. How can you increase your chances of a good outcome? Choose a hospital that can provide safe, high-quality care. But, how do you choose a hospital for cancer treatment? Read on to learn more.

Which hospital you choose for cancer treatment matters.

As you might expect, decades of research shows that hospital choice significantly impacts cancer survival rates. Receiving complex cancer treatment from a hospital where doctors don’t have adequate training and experience can increase the risk of death from surgical complications by 4x. Conversely, teaching hospitals with high volumes, along with high volume surgeons, have superior long-term cancer survival rates.

The type of hospital matters too!

Researchers at Memorial Sloan Kettering Cancer Centerphoto modern hospital building - choose a hospital for cancer analyzed 5 years of data for almost 750,000 cancer patients, including those with lung, prostate, breast or colon cancers. Each patient started cancer treatment of a new or recurring cancer in 2006. The study found that patients treated at specialized cancer centers had a 9% higher survival rate over 5 years as compared to cancer patients treated at community hospitals.

The study found differences in survival outcomes for 4 types of hospitals that treat cancer patients. (NOTE – this study analyzed data from patients treated between 2006 – 2011. The numbers below may not reflect current data. Additionally, in the US, there are more than 32 NCI-designated hospitals and more than 252 “other” teaching hospitals – this chart refers to the hospitals included in this study.)

*PPS is a hospital-reimbursement system in which Medicare payments are made based on a predetermined and fixed amount. To quality, hospitals must submit quality measures to the Centers for Medicare & Medicaid Services.

What about affiliated hospitals?

photo caution signIncreasingly, top-ranked cancer hospitals share their name and branding with smaller, unranked hospitals, creating “affiliated hospitals”. Affiliated hospitals are usually smaller and less likely to be teaching hospitals. Moreover, their surgeons generally perform fewer complex surgical procedures than those at top-ranked hospitals.

One example.

The University of Texas MD Anderson Cancer Center, a recognized world leader in cancer care, has 5 co-branded affiliated hospitals in the US. Their website states that these partner members “have a fully integrated cancer program based on our standards of care and treatment plans”. Is that true? Do affiliated hospitals provide the same level of care as their top-rated partner?

Is the quality of care the same at affiliated hospitals?

Top-ranked cancer hospitals have earned a reputation for safety and quality that unfortunately does not extend to all of their affiliated hospitals. In other words, the top-ranked name on the building does not guarantee a premium level of care. However, many of us assume that it does. In fact, 50% of survey respondents thought the safety and quality of surgical care would be the same between top-ranked hospitals and their smaller affiliates.

But the data suggests otherwise.

Affiliated hospitals have worse cancer survival rates.

photo nurse giving chemo to male patient in hospital bedResearchers from Yale University recently evaluated survival rates for patients across the US, comparing outcomes for top-ranked hospitals with those of their affiliated hospitals.

For this study, they deemed a hospital “top-ranked” if it was included in the widely recognized list of the top 50 cancer hospitals by US News and World Report at least once between 2013 and 2016. The “affiliated” hospitals were brand-sharing affiliates that either included the top-ranked brand name in their name, or were listed as affiliates in the American Hospital Association’s annual survey. Interestingly, 97.3% of the top-ranked hospitals were academic hospitals, compared to only 20% of the affiliates.

These researchers evaluated data from the National Cancer Database of nearly 120,000 patients. Each patient had surgery between 2012 – 2016 for one of the following cancers: esophageal, gastric, lung, pancreatic, colorectal, and bladder.

What did the results show?

Their findings are concerning, and eye-opening:

  • The probability of death within 90 days of surgical treatment for cancer was higher at affiliated hospitals, as compared to the top-ranked hospital with whom they partner.
  • The long-term survival after cancer treatment at affiliated hospitals was only 77% that of top-ranked hospitals.
  • 20.8% of patients at top-ranked hospitals received chemotherapy before their surgeries, compared to 7.8% at affiliated hospitals.
  • 12.3% of patients at top-ranked hospitals received radiation treatments before surgery, compared to 5.1% at affiliated hospitals.

It wasn’t all bad news:

  • A staging or diagnostic procedure was performed in 60.9% of patients at top-ranked hospitals and 61.5% of patients at affiliates.
  • The rates of unplanned 30-day readmissions after surgery were similar.
The takeaway.

The top-ranked hospitals had superior rates of long- and short-term survival for patients who had surgeries for cancer, as compared to their affiliates (even after adjusting for the higher volume of surgeries in the top-ranked hospitals). Additionally, the researchers suggest that non-surgical care, as well surgical care, might be superior at top-rated cancer hospitals.

Another study shows similar results.

A similar, but smaller study at Yale University evaluated the outcome of almost 30,000 Medicare patients who underwent complex cancer surgery at top-ranked hospitals and their affiliates between 2013 – 2016. As with the above study, researchers used the ratings by US News and World Report to identify “top-rated” cancer hospitals.

What did they find?

Researchers found that the patients treated at the affiliated hospitals were significantly more likely to die within 90 days of surgery compared to those who had surgery at top-rated hospitals.

How to choose a hospital for cancer treatment.

photo of doctors doing rounds in hospital room - choose a hospital for cancerCertainly, getting information about the safety and quality of care is a critical part of choosing a hospital for cancer treatment. However, no matter what hospital you use for cancer treatment, there is no guarantee of success. Nonetheless, it’s worth your time and effort to seek treatment at a hospital where you have an improved chance of a positive outcome. Your life may literally depend on your hospital choice.

When deciding where to have cancer treatments, you can choose a hospital and then look for a doctor within the hospital’s network. Conversely, you can choose a doctor and then use the hospital with which he/she is affiliated. Although either is an acceptable route, this post focuses on choosing a hospital for cancer care.

Note that larger hospitals usually have more experience in treating cancer, including less common cancers. And they are more likely to have clinical trials that you may be able to participate in.

How do you find top-rated cancer hospitals?

Use the following websites to find a top-rated hospital:

  1. US News and World Report’s list of the 50 Best Hospitals for Cancer in the US.
  2. The Center for Medicare and Medicaid Service’s 11 PPS-Exempt Cancer Hospitals (PCHs)*
  3.  The National Cancer Institute’s 71 NCI-Designated Cancer Centers.*

*NOTE – research found no significant differences in cancer surgery outcomes between  the NCI Cancer Centers and the PPS-exempt cancer hospitals. Hospitals in both groups   deliver cutting-edge cancer treatments.

Importantly, don’t forget that affiliated hospitals may not have as successful cancer outcomes as compared to their top-rated partner. So don’t choose an affiliated hospital without first conducting research.

photo Black doctor - choose a hospital for cancerOther ways to find possible hospitals for cancer treatment.
  1. Ask your doctors, including your primary care doctor, for recommendations. However, beware that doctors often refer patients to doctors and hospitals in their own networks, potentially missing a top-rated hospital.
  2. Look for teaching hospitals in your area, search for “teaching hospital” and your location.
  3. Search the list of over 1,500 US cancer centers on the American College of Surgeons’ Commission on Cancer website. The list of approved hospitals or facilities have committed to provide the best in cancer diagnosis and treatment. The site provides information on types of services offered at each facility, including the availability of diagnostics, radiation, chemotherapy, transplants, support groups and more.
  4. Review The Leapfrog Group’s lists of Best Hospitals and Best Teaching Hospitals. (They assign letter grades to hospitals based on their record of patient safety.)
Learn about hospital ratings and reviews.

Before you make a final choice of a hospital, conduct some research.

  1. For starters, there are many sites you can use to evaluate a doctor and/or hospital. You can find a list, along with a disclaimer on taking ratings information with a grain of salt, on the Zaggo Resource Center.
  2. Read reviews on independent sites, such as GoogleYelp, ZocDoc, HealthgradesAngie’s List and RateMDs. Surprisingly, research shows that these reviews and ratings are useful and reliable. For more information, read my blog post What do Doctors Think About Online Reviews and Ratings?
  3. Talk to people you know who have been treated for cancer at a hospital you are considering.
Find out about specific experience with your cancer!

Before making a decision, find out the experience level of prospective doctors or surgeons at the hospital you are considering. Ask how many cases like yours they treat in the hospital each year. And don’t be afraid to ask for statistics on outcomes!

Don’t let distance dictate your choice of hospital.

photo of car driving on country roadYes, it can feel impossible to travel to a top-rated cancer hospital for treatment. Concerns about money, logistics, work, childcare and other responsibilities may make it seem that you must choose a hospital near your home. But I urge you to reconsider. Importantly, don’t think you must have all of your treatments and appointments in one location. Perhaps you can have surgery in a top-rated hospital and then have radiation treatments closer to home. Or perhaps your doctor at a top-rated hospital can prescribe chemotherapy or radiation treatments that you can receive at a hospital closer to home.

If you have a rare cancer, you may not find a local doctor or hospital with experience in treating your cancer. In these situations, it’s definitely worth your time and efforts to travel to a doctor and facility with experience treating your cancer.

Money matters.

Before you make your final choice, investigate your insurance coverage. Call your insurance provider and ask them about coverage, limitations, deductibles and co-pays for any hospital (or doctor) you are considering.

For more information…

To learn more about choosing a hospital, read:

And, I suggest you read these blog posts before deciding on your course of treatments:

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