The role of the American College of Surgeons' cancer program accreditation in influencing oncologic outcomes.

The multidisciplinary Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC), administered by the American College of Surgeons (ACoS), defines evidence and consensus-based standards, require an operational infrastructure, collect high quality cancer data, and validate compliance with standards through external peer review. A survey of our constituents confirms a high level of agreement that accreditation is regarded as important in improving oncologic outcomes through compliance with standards that include continuous quality improvement.

Have racial disparities in ovarian cancer increased over time? An analysis of SEER data.

OBJECTIVE: Race has been postulated to be a prognostic factor in women with ovarian cancer. The reasons for racial disparities are multifactorial. Recent literature suggests that racial disparities in ovarian cancer survival emerged in the 1980s, when modern treatments such as aggressive surgical debulking and platinum-based chemotherapy first gained widespread use. We suspect that as improvements in treatment have evolved, the effects of access to treatment have amplified racial disparities in survival from ovarian cancer. METHODS: SEER 9 data were analyzed, including African American and white patients diagnosed with ovarian cancer from 1973 to 2007, with 2008 as the cutoff for follow-up. Using the Kaplan-Meier method, we evaluated racial differences in survival, to determine whether this difference has increased over time. RESULTS: There were 44,562 white and 3190 African American women available for analysis. Overall African Americans had 1.10 times the crude hazard (95% CI 1.06-1.15) of all-cause mortality compared to whites, with a widening trend over time (p<0.01). Adjusted for SEER registry, age, tumor stage, marital status and time of diagnosis, the hazard ratio (HR) for all-cause mortality comparing African Americans to whites was 1.31 (95% CI 1.26-1.37). When the receipt of surgery was added to the model, the HR for all-cause mortality remained higher for African American women at 1.27 (95% CI 1.21-1.34). CONCLUSIONS: African Americans diagnosed with ovarian cancer have worse survival than whites, and this disparity has increased over time. Measured differences in treatment, such as receipt of surgery, account for part of the disparity.

ReCAP: Impact of Multidisciplinary Care on Processes of Cancer Care: A Multi-Institutional Study.

PURPOSE: The role of multidisciplinary care (MDC) on cancer care processes is not fully understood. We investigated the impact of MDC on the processes of care at cancer centers within the National Cancer Institute Community Cancer Centers Program (NCCCP). METHODS: The study used data from patients diagnosed with stage IIB to III rectal cancer, stage III colon cancer, and stage III non­small-cell lung cancer at 14 NCCCP cancer centers from 2007 to 2012. We used an MDC development assessment tool­with levels ranging from evolving MDC (low) to achieving excellence (high)­to measure the level of MDC implementation in seven MDC areas, such as case planning and physician engagement. Descriptive statistics and cluster-adjusted regression models quantified the association between MDC implementation and processes of care, including time from diagnosis to treatment receipt. RESULTS: A total of 1,079 patients were examined. Compared with patients with colon cancer treated at cancer centers reporting low MDC scores, time to treatment receipt was shorter for patients with colon cancer treated at cancer centers reporting high or moderate MDC scores for physician engagement (hazard ratio [HR] for high physician engagement, 2.66; 95% CI, 1.70 to 4.17; HR for moderate physician engagement, 1.50; 95% CI, 1.19 to 1.89) and longer for patients with colon cancer treated at cancer centers reporting high 2MDC scores for case planning (HR, 0.65; 95% CI, 0.49 to 0.85). Results for patients with rectal cancer were qualitatively similar, and there was no statistically significant difference among patients with lung cancer. CONCLUSION: MDC implementation level was associated with processes of care, and direction of association varied across MDC assessment areas.

Improving quality of cancer care at community hospitals: impact of the National Cancer Institute Community Cancer Centers Program pilot.

PURPOSE: Patients with cancer treated at community hospitals may experience decreased quality of care compared with patients treated at higher-volume cancer hospitals. The National Cancer Institute Community Cancer Centers Program (NCCCP) pilot is designed to enhance research and improve cancer care at community hospitals. We assessed changes in quality of care among the 16 initial NCCCP sites versus 25 similar hospitals that did not participate in the NCCCP. METHODS: We compared changes in concordance with five National Quality Forum-approved quality of care measures (three for breast cancer, two for colon cancer) for patients diagnosed from 2006 to 2007 (pre-NCCCP initiation) versus 2008 to 2010 (post-NCCCP initiation) at NCCCP and comparison-group hospitals. Data were collected using the Commission on Cancer Rapid Quality Reporting System. Analyses were performed using multivariate logistic regression. RESULTS: Analyses included 18,608 patients with breast cancer and 7,031 patients with colon cancer. After NCCCP initiation, patient-level concordance rates for all five quality-of-care measures increased significantly among NCCCP and comparison-group hospitals. Increased quality of care among NCCCP sites was significantly greater than that among comparison-group hospitals for radiation therapy after breast-conserving surgery and hormonal therapy for women with hormone receptor-positive breast cancer. In multivariate regressions, increases in hormonal therapy among NCCCP-site patients were significantly greater than those among comparison-group hospitals. CONCLUSION: Both NCCCP and comparison-group hospitals showed improved quality of care; however, NCCCP sites had significantly greater improvements for a subset of measures. This greater increase may reflect the multidisciplinary focus of the NCCCP. Because many individuals receive cancer treatment at community hospitals, facilitating high-quality care in these environments must be a priority.

Pregnant and non-pregnant women with substance use disorders: the gap between treatment need and receipt.

Differences in pregnant and non-pregnant women's alcohol and drug use, substance treatment need, and treatment receipt were examined using The National Survey of Drug Use and Health (2002-2006). Treatment need and receipt were defined by either self-report or DSM-IV criteria. Pregnant women were less likely to use alcohol and drugs than non-pregnant women. Among women who use drugs, pregnant women were more likely to need treatment (odds ratio (OR) = 1.92; 95% confidence interval (CI): 1.46, 2.52), however they were not more likely to receive treatment (OR = 0.90; 95% CI: 0.54, 1.51). Overall, there is an unmet need for treatment among reproductive-aged substance users.

Small-cell lung cancer: prognostic factors and changing treatment over 15 years.

BACKGROUND: The incidence of small-cell lung cancer (SCLC) has decreased over several decades. Sixty-eight thousand six hundred eleven patients with SCLC in the National Cancer Data Base (NCDB) were analyzed to describe demographic, treatment, and survival changes between 1992 and 2007. METHODS AND MATERIALS: Four patient cohorts-diagnosed in 1992, 1997, 2002, and 2007-were examined. Univariate and multivariate analyses were performed to determine changes in demographic and treatment factors and their effect on survival of limited SCLC (LSCLC) and extensive SCLC (ESCLC). RESULTS: The proportion of female patients increased, whereas the proportion of non-Hispanic white patients decreased. Median survival for patients with ESCLC and LSCLC was 6.1 and 12.9 months, respectively, and was not significantly improved between patients diagnosed in 1992 and 2002. Improved survival was associated with female sex, age < 70 years, and receipt of surgery for patients with LSCLC. Radiation therapy decreased the hazard ratio (HR) for patients with stage III LSCLC but not for patients with earlier stage disease. Chemotherapy decreased the HR for all patients with LSCLC. Patients with ESCLC treated with radiation in addition to chemotherapy had better survival than those who received only chemotherapy. CONCLUSIONS: Despite changes in demographics and treatment, the median and 5-year survival rates for patients with SCLC have not significantly improved over the past 15 years. Surgery was associated with improved survival in LSCLC. The benefit of chemotherapy and/or radiation therapy was dependent on American Joint Committee on Cancer (AJCC) stage. AJCC staging information had prognostic and treatment ramifications and should be collected in future studies and databases.