When it comes to cancer surgery, choosing the right hospital is crucial — and according to a new study, patients who have their surgeries at hospitals affiliated with top-ranked cancer centers may have a better chance of surviving.
The study, led by a team of Yale Medicine researchers and published last month in JAMA Oncology, found that overall mortality rates after cancer surgery (that is, the percentage of people who died after their cancer surgeries) were 9 percent lower at cancer center-affiliated hospitals than at hospitals without the affiliation.Read More
The data suggests you may be better off choosing a hospital with one of these affiliations. But the experts have also told SurvivorNet that when it comes to cancer surgery, “who” might be more important than “where.” Choosing a surgeon you feel comfortable with is an extremely important aspect of your cancer surgery decision.
Choosing the Right Surgeon: Think Volume, Comfort, and Communication
“You need to be able to trust that physician,” Dr. Jay Shah, a urologic oncologist at Stanford Medicine told SurvivorNet in a previous conversation about choosing a surgeon. “Look them in the eye and trust your gut.” Dr. Shah went on to explain that you’ll likely develop a lasting relationship with the cancer surgeon you choose, making this gut feeling all the more important. “The surgery will pass, but you’re going to see this person 6 months later, and 12 months later, and 5, and 6, and 10 years later,” Dr. Shah said.
Dr. Shah also recommended taking into account the number of times your surgeon has performed the specific surgery you’re getting.
“You don’t want the person who’s never done any [of your surgery] and is excited to learn how to do the case on you. You don’t want to be that patient for that surgeon,” he said. “But you also don’t want to be the patient for the surgeon who does eight of these in a day because it’s not physically possible for one person to do eight of them in a day.” In these cases — where your surgeon performs “eight in a day,” Dr. Shah said, “What’s more likely happening in that scenario is that there are other junior surgeons who are doing most of that operation and that surgeon is overseeing them.”
Dr. Raja Flores, Chairman of the Department of Thoracic Surgery at Mount Sinai, told SurvivorNet that, in the process of choosing a cancer surgeon, patients shouldn’t be afraid to ask doctors tough questions — including, for instance, questions about their compensation and financial incentives.
Dr. Flores explained that surgeons who get paid on a case-by-case basis may find more incentive to recommend surgery for a person with cancer, and that’s something to look out for.
“I don’t think there is any offensive question that a patient can ask a doctor,” Dr. Flores said, adding that it can also be important to ask a doctor about their complication rate. “Any doctor that tells you he has a zero complication rate, go running,” he said. “There are some doctors that are going to have a lower complication rate based on experience, and that’s what you want. You want the person that has a high volume, that is going to have a minimal amount of complications, but that doesn’t mean it’s zero.”
Apart from complication rates, your comfort level with the surgeon, and how many times they’ve performed your specific procedure, Dr. Heather Yeo, a medical advisor to SurvivorNet and a colorectal cancer surgeon at the NewYork-Presbyterian Hospital/ Weill Cornell Medical Center, said that your surgeon’s communication skills should also factor into your decision.
“I think that it’s really important that a physician can explain stuff to patients,” Dr. Yeo said. “You can be technically very good surgeon, but if you can’t have a conversation with a patient and explain to them why they need a certain procedure, and get them through the process, then you may make the wrong decisions for them.”
What is a “Top Cancer Center” and Why Does it Have Better Outcomes?
In terms of the “where” question and the new research findings about survival outcomes, it’s important to understand that the “top-ranked” status of a cancer center isn’t just about the reputation that comes with a well-known name (such as a Memorial Sloan Kettering or an MD Anderson).
We previously asked Dr. Kenneth Miller, the director of outpatient oncology at the University of Maryland School of Medicine, what differentiates a “comprehensive cancer center”—which many of the “top” cancer centers are.
“Pretty much automatically, there’s going to be a team approach [to your care],” Dr. Miller said. “Surgical oncology, medical oncology, radiation oncology, and all the support services—and also wonderful pathology and radiology.” Dr. Miller explained that at a comprehensive cancer center, all of these different specialists work together as a team to help you find the best course of treatment for your specific cancer.
“We call it a tumor board—a group to go through all the details of your case… so you get a group of very smart people coming up with a plan together that is hopefully optimal and gives you the best chance of doing well.”
Dr. Yeo also told us how important it is that a cancer center takes a team approach to treating its patients.
“We meet every week to talk about all of the patients,” Dr. Yeo said of her multidisciplinary team. “While colon cancer has standard courses and standard treatments, there are new drugs and new trials coming out all the time, and so it’s really important for each patient that you have a discussion.”
The “NCI Designation” Difference
The U.S. News and World Report’s “Best Cancer Hospitals” list that the researchers used for their study factored in a lot of variables (some of them less objective than others) in ranking the hospitals.
One of these variables was whether the hospital was a National Cancer Institute (NCI)-Designated “clinical cancer center” or “comprehensive cancer center.” These designations are important; if a hospital is an NCI-Designated clinical cancer center, that means that the hospital’s researchers are conducting clinical trials and involving their patients in their cutting-edge research. (This is called a “bench-to-bedside” approach, and it means that the researchers aren’t just developing new cancer drugs in a lab—they’re actually testing their discoveries in real patients.)
If a hospital is an NCI-Designated “comprehensive cancer center,” that means its doctors and researchers are conducting this research at the “highest level,” and are also working to prevent cancer, not just to treat it. NCI designation also plays into the federal funding these hospitals receive for their cancer research.
I Already Had Surgery at a Non-affiliated Cancer Center—Should I Be Worried?
Not at all. It’s really important to remember that every cancer hospital is different, and the best place to schedule a surgery for your specific type and stage of cancer may not be the same as someone else’s “best” place.
Plus, the researchers themselves said that their study didn’t prove that the better survival outcomes after surgery were because of the top-hospital affiliation; the study was designed only to look at the association between the rates and the affiliations, not to prove that one caused the other.
Another reason not to worry is that the U.S. News and World Report list (the one this study was based on) didn’t even consider smaller cancer centers (with fewer than 100 beds) for their rankings—which means that many of these smaller cancer centers may be just as good, if not better, but were just too small for consideration.
For many patients, survival outcomes could be just as good at a small center close to home than a larger hospital associated with a major cancer center—and for many patients, the close-knit community experience might be preferable to the large hospital in a major city.
Ultimately, the right surgeon for you and the right hospital or cancer center for you should be one that makes you feel comfortable and confident—and no rankings website can tell you that.
“Patients should not make any assumptions simply because the brand of a prestigious hospital is on the sign or webpage of a hospital in their community,” Dr. Daniel Boffa, a thoracic surgeon at Yale Medicine and one of the lead authors on the new study told Reuters Health. “Patients should take the time to investigate the safety within the hospitals in their specific area.”