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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 (http://www.interscience.wiley.com/cancer-newsroom), 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.
Article: "Do Cancer Centers Designated by the National Cancer Institute Have Better Surgical Outcomes?" Nancy J. O.
Birkmeyer, Philip P. Goodney, Therese A. Stukel, Bruce E. Hillner, John D. Birkmeyer, CANCER; Published Online: December 27,
2004 (DOI: 10.1002/cncr.20785); Prints Issue Date: February 1, 2005.
http://www.interscience.wiley.com
Studiul investigheazã valoare de "centru de excelenþã" denumire - Study investigates value of 'center of excellence' designation - articole medicale engleza - startsanatate