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Check Please: Choosing the Best Hospital for Your Cancer Surgery

Taking the time to do your homework can help when it comes to choosing a hospital for your cancer surgery.

BY CHARLOTTE HUFF
PUBLISHED TUESDAY, JUNE 18, 2013
For nine months before Tom Murphy was rolled into the operating room for removal of a suspicious nodule on his lung, the 58-year-old management consultant vetted available surgical resources. His research involved surfing hospital websites, studying rankings and becoming involved with online cancer forums.

Because Murphy was a former smoker with other risk factors (including exposure to Agent Orange and radon gas), he had been undergoing computed tomography scans since his mid-50s. The suspicious nodule was identified by a scan in early 2010.

During subsequent months, as Murphy returned for additional scans that pointed to (but didn’t confirm) cancer, he realized that surgery was increasingly likely. That's when he began researching hospitals where he could receive the best surgical outcome with minimal post-surgical complications. His research focused on high-profile facilities, such as The Johns Hopkins Hospital in Baltimore, MD Anderson Cancer Center in Houston and Moffitt Cancer Center in Tampa, Fla., as well as hospitals closer to his home in central Maryland.

The investigation became a part-time job, one that wouldn’t have been feasible if he hadn’t been self-employed, he says.

"It was kind of like a shotgun [approach]," Murphy says. "Some of the sites I hit were helpful, and some weren't. I would have loved to have gone to a site that I felt gave me objective assessments."

While many healthcare professionals benefit from insider knowledge of high-quality facilities and providers, patients facing cancer surgery have relatively few resources beyond marketing materials and their doctor’s recommendation.

"It's always bothered me—how does the average cancer patient find the right place to go?" asks Daniel McKellar, a clinical professor of surgery at Wright State University in Dayton, Ohio. "There needs to be more available data."

Providing public access to treatment outcomes in an accurate and understandable way is improving, but it’s a work in progress, according to McKellar.

How does the average cancer patient find the right place to go?  There needs to be more available data.

In recent years, federal officials began publishing some hospital readmission and infection rates, as well as other treatment barometers, on Medicare's Hospital Compare website (medicare.gov/hospitalcompare). The bulk of the findings, particularly for outcomes like death rates, are restricted to heart-related issues and pneumonia. But some of the information is more relevant to cancer patients, such as post-surgical infections and the frequency with which surgical procedures are being followed, such as removing a patient's urinary catheter within two days after surgery.

The data "are all worth something," says Peter B. Bach, an epidemiologist who directs the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center in New York City. "I think the mistake would be to assume that they tell you a great deal about the quality of care in that hospital."

Where surgical data isn't available, patients should ask very specific questions to gain a better sense of a facility's expertise, says John Sweeney, chief of the division of general and gastrointestinal surgery at Emory University School of Medicine in Atlanta. He recommends patients ask about the number of similar procedures the surgeon has performed, as well as how many similar procedures have been done at that particular facility. Also of interest, the hospital's readmission rate and the hospital’s complication rates. "Those are fair things to ask," Sweeney says.

Unlike Murphy, many patients who have just received a cancer diagnosis aren't likely to launch cross-country searches, preferring instead to get their treatment close to home and to follow the recommendation of a trusted doctor, McKellar says.

But those who want to dig further can become quickly flummoxed. A writer in suburban Philadelphia recently posted her frustration about a family member’s possible stomach cancer diagnosis and treatment options on an online forum. "It's not like you can Google 'best cancer hospital' and expect to get unbiased results," she wrote, asking for strategies to locate the best facility for treating stomach cancer.

One good way to start is by searching for a hospital that's accredited by an external organization, such as the National Cancer Institute, says John Birkmeyer, who teaches surgery and directs the Center for Healthcare Outcomes and Policy at the University of Michigan in Ann Arbor, Mich. The Commission on Cancer, created by the American College of Surgeons, also has an accreditation process. The more than 1,500 accredited cancer facilities make up 30 percent of all U.S. hospitals but care for about 70 percent of cancer patients, according to McKellar, who chairs the commission.

External or independent hospital rankings can also provide partial insight into a facility, reflecting some insider perspective, Birkmeyer says.

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