Variation in long-term oncologic outcomes by type of cancer center accreditation: An analysis of a SEER-Medicare population with pancreatic cancer - 05/04/20

Doi : 10.1016/j.amjsurg.2020.03.035

Zhi Ven Fong ^a, David C. Chang ^a, Chin Hur ^b, Ginger Jin ^a, Angela Tramontano ^b, Naomi M. Sell ^a, Andrew L. Warshaw ^a, Carlos Fernandez-del Castillo ^a, Cristina R. Ferrone ^a, Keith D. Lillemoe ^a, Motaz Qadan ^a,^⁎
^a Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
^b Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA

^∗Corresponding author. Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, 02114, MA, USA.Department of SurgeryMassachusetts General Hospital55 Fruit StreetYawkey 7BBostonMA02114USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Sunday 05 April 2020

Abstract

Background

Cancer center accreditation is designed to identify centers that provide high-quality cancer care. This also guides patients and referring physicians towards centers of excellence for specialized care. We sought to examine if cancer center accreditation was associated with improved long-term oncologic outcomes in patients with pancreatic adenocarcinoma.

Methods

Using the SEER-Medicare database, we identified patients who underwent pancreatectomy for pancreatic adenocarcinoma from 1996 to 2013. Hospitals were categorized into three groups: National Cancer Institute-designated (NCI-designated) centers, Commission on Cancer (CoC)-accredited centers, and “non-accredited” (NA) centers. Multilevel mixed-effects models were used to calculate adjusted examined lymph nodes, disease-specific survival (DSS), and overall survival (OS).

Results

We identified 5,118 patients who underwent pancreatectomy at 632 hospitals (41.0% NA, 49.6% CoC, 9.4% NCI). NCI-designated centers had a greater median number of lymph nodes examined compared with CoC-accredited or NA centers (14 vs. 10 vs. 11.0 nodes, respectively; p < 0.001). Patients treated at NCI centers had a higher 5-year DSS compared to those treated at CoC or NA centers (31.2% vs. 23.6% vs. 23.0%, respectively; p < 0.001). Finally, patients treated at NCI centers had a higher 5-year OS compared to those treated at CoC or NA centers (23.5% vs. 18.9% vs. 17.9%, respectively; p < 0.001). The associations held true when adjusted analyses were performed.

Conclusion

Patients with resected pancreatic cancer treated at NCI-designated centers were associated with improved long-term oncologic outcomes. There was no difference between CoC-accredited centers compared with NA centers. Meticulous validation of accreditation is warranted globally prior to implementation.

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Highlights

•	Patients treated at NCI-designated centers had improved survival outcomes.
•	No differences in survival outcomes between CoC-centers and non-accredited centers.
•	Future studies into individual accreditation process elements are warranted.

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Keywords : Cancer center accreditation, Oncologic outcomes, Survival, Variation, Pancreatic cancer