The U.S. News and World Report has just published its annual list of the “best hospitals” for treating cancer.
But what does it really mean to be treated at a “best” hospital? Does the “rank” of your hospital determine your chance of surviving cancer? When it comes to rankings, there are a lot of factors to keep in mind. Here’s your guide to the list.Read More
It probably won’t come as a surprise to read the names of what the U.S. News and World Report considers the top 10 cancer hospitals in the U.S.:
- The MD Anderson Cancer Center in Houston, TX
- Memorial Sloan Kettering Cancer Center in New York City
- The Mayo Clinic in Rochester, MN
- Johns Hopkins Hospital in Baltimore, MD
- Dana-Farber/Brigham and Women’s Cancer Center in Boston, MA
- The Cleveland Clinic in Cleveland, OH
- UPMC Presbyterian Shadyside in Pittsburgh, PA
- H. Lee Moffitt Cancer Center and Research Institute in Tampa, FL.
- Massachusetts General Hospital in Boston, MA
- Northwestern Memorial Hospital in Chicago, IL
What Does it Mean to Be a “Best” Hospital?
According to the U.S. News and World Report, the hospitals were judged, in a large part, on objective criteria, such as patient outcome data (how many patients survived their condition and got better, for instance), ratios of doctors and nurses to patients, and the technologies the hospitals offered.
Then there were the not-so-objective criteria that the U.S. News and World Report factored into its list: expert opinions based on survey results sent to leading doctors, and patient experience, based on surveys that patients filled out about their care.
As far as outcomes go, the data is there; according to a 2015 study published in the Journal of the American Medical Association, patients treated in academic or teaching hospitals had a “10 percent lower chance of dying in the first year than patients treated at other non-teaching hospitals.” It’s worth noting, though, that some experts, including Dr. Derek Raghavan, President of the Levine Cancer Institute, say that survival outcomes depend on how sick someone is to begin with, too–not just on how good their treatment is.
“It is hard to correct for referral patterns by which the sickest patients are seen in the best places,” Dr. Raghavan told SurvivorNet in a previous conversation about these hospital rankings. “This puts further strains on their outcome measures.”
The full methodology (that is, their “how we decide” explanation) is explained on the U.S. News and World Report’s website.
What Does it Mean for a Hospital to be “NCI-Designated”?
The report also factored in 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. There are 71 NCI-designated cancer centers in the U.S. (the University of Miami’s Sylvester Comprehensive Cancer Center was just added to the list this week).
Apart from the research aspect, we previously asked Dr. Kenneth Miller, the director of outpatient oncology at the University of Maryland School of Medicine, what it is that makes a comprehensive cancer center different.
“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. Heather Yeo, a medical advisor to SurvivorNet and a colorectal cancer surgeon at the NewYork-Presbyterian Hospital/ Weill Cornell Medical Center, told us about 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.”
A Pretty Short List for a Huge Population
Take a minute to scroll up and reread the list of the U.S. News and World Report’s “best” cancer hospitals. Notice anything in common?
They’re all located in major cities.
According to the NCI, “each year, approximately 250,000 patients receive their cancer diagnoses at an NCI-Designated Cancer Center,” and “an even larger number of patients are treated for cancer at these centers.” Meanwhile, an estimated 1.7 million people were diagnosed with cancer in 2018. It goes without saying that 250,000 is a far cry from 1.7 million.
The elephant in the room, when it comes to these rankings, is that the majority of people with cancer aren’t able to get to one of these places. Many patients live too far from one of these major cities and can’t afford to travel back and forth for treatment.
And while there are foundations and organizations that offer travel and lodging help for those who need it, many patients simply can’t leave home for that long. Maybe they have a family at home they want to stay close to during their cancer treatment. Maybe they have a physical limitation to traveling. Maybe location isn’t so much a factor, but they don’t have the right insurance to get to one of these centers.
For all of these reasons and many more, only 15 percent of patients with cancer receive their care in larger, generally urban academic centers, according to a study published in the Journal of the National Cancer Institute this past February. Eighty-five percent of patients don’t make it to one of these major centers; instead, they receive treatment and care at nearby hospitals and community oncology practices, which refer to the private, physician-owned businesses that are not a part of a hospital or major academic or teaching institution. Community oncology practices treat fifty-five percent of patients with cancer.
Smaller Doesn’t Necessarily Mean Worse
Community oncology practices vary in size. Many of them were too small to be considered for the U.S. News and World Report’s “best” list at all. But that doesn’t mean the care they’re offering isn’t state-of-the-art; for many patients, survival outcomes could be just as good at a small center close to home, and for many patients, the close-knit community experience might be preferable to the large, bustling hospital.
According to the Community Oncology Alliance, a group that advocates for these centers and tries to keep major hospitals from taking their resources, community oncology practices are often more affordable for patients, and they deliver “quality care, usually within a few miles of the patient’s home.”
The bottom line is that there are a lot of wonderful places out there that will care for you and treat you throughout your cancer journey. Every patient has different circumstances, and every cancer requires a unique type of care. There’s also no one rule that says the center you visit at first has to be the center you stick with. You might instead visit a number of different hospitals for second opinions before deciding on the right place for you.
Ultimately, the right hospital or cancer center for you should be one that you and your doctor decide on—and no rankings website can make that decision for you.