ASO Author Reflections: How can we improve the quality of cancer treatment in community hospitals?

Past

The majority of cancer patients in the U.S., 80 to 85%, are treated in community hospitals.¹ This percentage is very likely even higher for common malignancies such as breast or colon cancer that can be treated by surgeons in hospitals of nearly any size. Being treated in a community hospital that is close to the patient’s home provides some distinct advantages for both the cancer patient and their family. This is especially true in rural areas were distances to larger University based hospitals can be much greater. However, cancer treatment is continually changing and it can be challenging for community hospitals to ensure that their patients have access to new treatments or diagnostic procedures such as genomic testing. There is also evidence that cancer patients treated in community hospitals receive less guideline-recommended care and experience poorer outcomes compared to patients treated in academic medical centers or National Cancer Institute (NCI)-Designated Cancer Centers.^2,3 Because of these disparities in cancer treatment and outcomes, NCI-Designated Cancer Centers are expected to work with communities and community hospitals to help ensure that cancer patients treated in community hospitals have access to high quality care.

Present

To address this issue in Kentucky, the University of Kentucky, NCI-Designated Markey Cancer Center has developed the Markey Cancer Center Affiliate Network (MCCAN). The Network is a collaboration between the Markey Cancer Center and community hospitals designed to enhance access to high-quality cancer services and programs for cancer patients treated in community hospitals throughout the state. As a requirement for joining the Network, community hospitals agree to seek American College of Surgeons, Commission on Cancer (CoC) accreditation. MCCAN staff work with community hospitals to help them meet the CoC requirements. MCCAN provides ongoing educational programs for clinicians and staff, including live events, webinars and instructional videos that address the clinical practice criteria necessary to treat cancer patients according to each of the CoC required quality of care measures that are evidence-based and endorsed by the National Quality Forum.⁴ Community hospitals that participated in the MCCAN showed significant improvements on four quality measures related to the treatment of breast and colon cancer compared to a matched set of control hospitals. Participation in the Network and the support of the MCCAN staff appear to significantly improve the quality of cancer care in the community hospitals.⁵

Future

Academic medical centers and NCI-Designated Cancer Centers have a limited capacity to treat cancer patients. Thus, it is very likely that the majority of cancer patients will continue to be treated in community hospitals well into the future. In order to improve the quality of cancer treatment in community hospitals, the methods developed by MCCAN and similar programs designed to improve the quality of cancer treatment in community hospitals need to be tested in other locations. When these methods are proven to be effective, they should be adopted by academic medical centers and NCI-Designated Cancer Centers and used to improve the quality of cancer care for patients treated in community hospitals throughout the country.