American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

New Study Sheds Insight into Cancer Center Differences

CoC facilities more likely to offer a full range of oncology related services and to be urban based


CHICAGO (September 2, 2009): A team of researchers affiliated with the National Cancer Data Base (NCDB) of the American College of Surgeons have published a first-time study that identifies the differences between hospitals accredited by the Commission on Cancer (CoC) and CoC nonaccredited hospitals. The authors indicate that other studies drawing on NCDB outcomes should acknowledge that the findings may not accurately represent the kind of care cancer patients are receiving at all types of centers, according to co-author David P. Winchester, MD, FACS, University of Chicago Pritzker School of Medicine, and Director, American College of Surgeons Cancer Programs.

“We’ve always questioned the representativeness of all reports we generate in the research field about cancer outcomes,” he explained. “We need to recognize that NCDB data may not be representative because of the differences we found in the characteristics of the hospitals in some past presentations of NCDB data.” The study was recently published online in the Journal of Clinical Oncology and will appear in a print version of JCO later this year.

Hospitals accredited by the CoC submit outcomes data to the NCDB, a joint program of the CoC and the American Cancer Society (ACS) that today contains approximately 23 million records. The CoC, established in 1922 by the American College of Surgeons, is a consortium of 46 professional and related organizations that establish cancer care standards and monitor quality at hospitals it accredits. Some 1,460 hospitals in the United States and Puerto Rico are CoC-accredited, and represent 29 percent of all institutions providing cancer treatment, but 70 percent of all new cancer cases diagnosed annually.

In comparing the CoC-accredited programs with the 3,500 CoC-nonaccredited hospitals, the NCDB researchers found that CoC programs were more likely to offer a full range of oncology-related services, ranging from breast cancer screening to chemotherapy to hospice and palliative care to radiation. For example, 84 percent of CoC-accredited programs offered chemotherapy service compared with just 42 percent of CoC-nonaccredited centers.

CoC-accredited centers were also more likely to be found in urban areas: 82 percent of CoC-accredited centers fit this description. In fact, a majority of hospitals in urban and suburban areas (1,153) are CoC-accredited (1,146 are not), whereas only 46 of 1,131 small rural hospitals are CoC-accredited. The study also found CoC-accredited hospitals are larger and more frequently accredited by other major oversight agencies. About 1,000 CoC-accredited hospitals are community based. The study did not look at CoC-nonaccredited centers critically. “The conclusions are not that one should not have cancer care at a CoC-nonaccredited hospital,” Dr. Winchester said. “This [study] is simply an analysis of some of the differences between the two types of hospitals. We do not have data for the 30 percent of patients who get their care at a CoC-nonaccredited hospital similar to that on the 70 percent who do.”

In commenting on the impact that the CoC and NCDB play in the field of cancer research, lead study author Karl Bilimoria, MD, observed, “The NCDB remains an invaluable resource for research as it provides details on 70 percent of all cancer cases in the U.S. It also includes many data points that other cancer registries do not routinely include.” Moreover, Dr. Bilimoria explained that the NCDB is unique in that it provides feedback to each individual hospital regarding their performance on outcomes measures (eg. five-year survival) and process measures (eg. administration of adjuvant chemotherapy for Stage III colon cancer).

“Hospitals that are CoC accredited clearly demonstrate a higher level of cancer specialization based on the crude measures that we examined. The CoC requirements and onsite surveys every third year ensure that hospitals meet certain basic criteria which are deemed important to provide high-quality cancer care,” observed Dr. Bilimoria, former research fellow at the American College of Surgeons and general surgery resident at Northwestern University, Department of Surgery, Chicago.

Findings from this new study may give insight to authors of future studies on cancer outcomes to acknowledge differences between hospitals based on their CoC-accreditation status, the researchers concluded.

In addition to Drs. Bilimoria and Winchester, contributing authors were David J. Bentrem, MD, FACS, (Northwestern University); Clifford Y. Ko, MD, FACS, (University of California at Los Angeles and VA Greater Los Angeles Healthcare System), and Andrew Stewart, MA (National Cancer Data Base of the American College of Surgeons).

The National Cancer Data Base--a joint program supported by the American College of Surgeons Commission on Cancer and the American Cancer Society--is recognized as the largest clinical registry in the world. It is a nationwide oncology outcomes database for more than 1,460 Commission on Cancer accredited cancer programs in the United States and Puerto Rico, and captures approximately 70 percent of all new invasive cancers diagnosed annually.

The study was supported by the American College of Surgeons Clinical Scholars in Residence program and the Department of Surgery, Feinberg School of Medicine, Northwestern University.

Citation: Bilimoria KY, Bentrem DJ, Stewart AK, Winchester DP, Ko CY. Comparison of Commission on Cancer-Approved and –nonapproved hospitals in the United States: Implications or studies that use the National Cancer Data Base. J Clin Oncol. 2009 Jul 27. [Epub ahead of print]

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The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 79,000 members and is the largest organization of surgeons in the world. For more information, visit


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