Survival After Cancer Treatment at Top-Ranked US Cancer Hospitals vs Affiliates of Top-Ranked Cancer Hospitals

Key Points

Question

Are there differences in survivorship between top-ranked cancer hospitals and affiliates that share a top-ranked hospital’s brand?

Findings

In this cohort study of 119 834 patients who underwent surgical treatment for esophageal, gastric, lung, pancreatic, colorectal, and bladder cancer, risk of 90-day mortality after complex cancer treatment was higher and long-term survival was inferior at affiliate hospitals.

Meaning

These findings suggest that quality improvement efforts are needed to address important differences in survival between top-ranked cancer hospitals and brand-sharing affiliate hospitals.

Abstract

This cohort study examines short-term survival outcomes among patients who receive cancer treatment at top-ranked cancer hospitals compared with those who receive cancer treatment at affiliate hospitals.

Abstract

Importance

Hospital networks formed around top-ranked cancer hospitals represent an opportunity to optimize complex cancer care in the community.

Objective

To compare the short- and long-term survival after complex cancer treatment at top-ranked cancer hospitals and the affiliates of top-ranked hospitals.

Design, Setting, and Participants

This cohort study was conducted using data from the unabridged version of the National Cancer Database. Included patients were individuals 18 years or older who underwent surgical treatment for esophageal, gastric, lung, pancreatic, colorectal, or bladder cancer diagnosed between January 1, 2012, and December 31, 2016. Patient outcomes after complex surgical procedures for cancer at top-ranked cancer hospitals (as ranked in top 50 by US News and World Report) were compared with outcomes at affiliates of top-ranked cancer hospitals (affiliation listed in American Hospitals Association survey and confirmed by search of internet presence). Data were analyzed from July through December 2019.

Exposures

Undergoing complex cancer treatment at a top-ranked cancer hospital or an affiliated hospital.

Main Outcomes and Measures

The association of affiliate status with short-term survival (ie, 90-day mortality) was compared using logistic regression, and the association of affiliate status with long-term survival was compared using time-to-event models, adjusting for patient demographic, payer, clinical, and treatment factors.

Results

Among 119 834 patients who underwent surgical treatment for cancer, 79 981 patients (66.7%) were treated at top-ranked cancer hospitals (median [interquartile range] age, 66 [58-74] years; 40 910 [54.9%] men) and 39 853 patients (33.3%) were treated at affiliate hospitals (median [interquartile range] age, 69 [60-77] years; 19 004 [50.0%] men). In a pooled analysis of all cancer types, adjusted perioperative mortality within 90 days of surgical treatment was higher at affiliate hospitals compared with top-ranked hospitals (odds ratio, 1.67 [95% CI, 1.49-1.89]; P < .001). Adjusted long-term survival following cancer treatment at affiliate hospitals was only 77% that of top-ranked hospitals (time ratio, 0.77 [95% CI, 0.72-0.83]; P < .001). The survival advantage was not fully explained by differences in annual surgical volume, with both long- and short-term survival remaining superior at top-ranked hospitals even after models were adjusted for volume.

Conclusions and Relevance

These findings suggest that short- and long-term survival after complex cancer treatment were superior at top-ranked hospitals compared with affiliates of top-ranked hospitals. Further study of cancer care within top-ranked cancer networks could reveal collaborative opportunities to improve survival across a broad contingent of the US population.