Study investigates value of ’center of excellence’ designation

A new study says cancer surgery performed at a medical center designated by the National Cancer Institute (NCI) as a “center of excellence” is associated with less risk of death soon after surgery than if performed at a high-volume surgery center, but finds no difference in five-year survival rates. The full study will be published in the February 1, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society. This study was supported by grants from the NCI and the Agency for Healthcare Research and Quality (AHRQ).

In 1971 the NCI created a program to award cancer centers special designation as centers of regional excellence if they demonstrated excellence in three areas: research, cancer prevention, and clinical services. NCI cancer centers are well staffed with specialists, tend to have high procedure volumes, and better access to multidisciplinary consultation and the latest therapies–all reasons to believe they would have better outcomes than other cancer centers. Although these centers often advertise their superior outcomes, say the study’s authors, to date their relative performance has not been examined.

Nancy J. O. Birkmeyer, Ph.D. from the Department of Surgery at the University of Michigan Medical School and her colleagues investigated whether this designation actually improves survival. The investigators reviewed data from 63,860 cancer patients who underwent cancer surgery. Patients treated at one of the 51 NCI cancer centers were compared to those from 51 control cancer centers with the highest volumes for each procedure.

Perioperative mortality was significantly lower at NCI-designated medical centers for four of six procedures: colectomy; pulmonary resection; gastrectomy; and esophagectomy. No significant difference in mortality was observed in patients treated with cystectomy or pancreatic resection at either type of institution.

Among patients surviving surgery, however, five-year survival rates for all six procedures did not differ significantly between NCI-designated cancer centers and control cancer centers for any of the procedures.

The authors conclude, “Our study suggests that NCI cancer center designation should be weighted less heavily than other factors in deciding where to undergo major cancer surgery.” And they reassure patients who do not live near an NCI cancer center, saying they can optimize their odds after cancer surgery by selecting high-volume surgeons with sub-specialty training, which they should be able to find at high volume cancer centers close to home.