Status of Cancer Care at Network Sites of the Nation’s Academic Cancer Centers

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  • 1 Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio;
  • | 2 Association of American Cancer Institutes, Pittsburgh, Pennsylvania;
  • | 3 Moffitt Cancer Center, Tampa, Florida;
  • | 4 University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, Hawaii;
  • | 5 UAMS Winthrop P. Rockefeller Cancer Institute, Little Rock, Arkansas;
  • | 6 UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
  • | 7 Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana;
  • | 8 University of Wisconsin Carbone Cancer Center, Madison, Wisconsin;
  • | 9 University of Colorado Cancer Center, Denver, Colorado;
  • | 10 Seidman Cancer Center, University Hospitals Cleveland Medical Center and Case Comprehensive Cancer Center, Cleveland, Ohio;
  • | 11 Georgetown Lombardi Comprehensive Cancer Center, Washington, DC; and
  • | 12 Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.
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Background: Cancer care coordination across major academic medical centers and their networks is evolving rapidly, but the spectrum of organizational efforts has not been described. We conducted a mixed-methods survey of leading cancer centers and their networks to document care coordination and identify opportunities to improve geographically dispersed care. Methods: A mixed-methods survey was sent to 91 cancer centers in the United States and Canada. We analyzed the number and locations of network sites; access to electronic medical records (EMRs); clinical research support and participation at networks; use of patient navigators, care paths, and quality measures; and physician workforce. Responses were collected via Qualtrics software between September 2017 and December 2018. Results: Of the 69 responding cancer centers, 74% were NCI-designated. Eighty-seven percent of respondents were part of a matrix health system, and 13% were freestanding. Fifty-six reported having network sites. Forty-three respondents use navigators for disease-specific populations, and 24 use them for all patients. Thirty-five respondents use ≥1 types of care path. Fifty-seven percent of networks had complete, integrated access to their main center’s EMRs. Thirty-nine respondents said the main center provides funding for clinical research at networks, with 22 reporting the main center provides all funding. Thirty-five said the main center provided pharmacy support at the networks, with 15 indicating the main center provides 100% pharmacy support. Certification program participation varied extensively across networks. Conclusions: The data show academic cancer centers have extensive involvement in network cancer care, often extending into rural communities. Coordinating care through improved clinical trial access and greater use of patient navigation, care paths, coordinated EMRs, and quality measures is likely to improve patient outcomes. Although it is premature to draw firm conclusions, the survey results are appropriate for mapping next steps and data queries.

Submitted May 13, 2020; final revision received September 21, 2020; accepted for publication September 22, 2020.

Published online March 11, 2021.

Author contributions: Study concept data analysis and interpretation: Gerson. Data collection: Shaw. Data analysis and interpretation: Gerson. Manuscript preparation: Gerson, Shaw. Survey design: Harrison, Holcombe, Hutchins, Lee, Loehrer, Mulkerin, Purcell, Teston, L.M. Weiner, G.J. Weiner.

Disclosures: Dr. Holcombe has disclosed serving as a scientific advisor for Merck. Dr. L.M. Weiner has disclosed receiving grant/research support from Bioxcel Therapeutics, Inc.; serving a scientific advisor for Bioxcel Therapeutics, Inc., Celldex Therapeutics, CytomX Therapeutics, Inc., Immunome, Inc., Jounce Therapeutics, Klus Pharmaceuticals, Inc., Samyang Biopharm USA Inc., Tessa Therapeutics; owning stock in Celldex Therapeutics, CytomX Therapeutics, Inc., Immunome, Inc.; a co-founder of Jounce Therapeutics; and serving as a consultant for Molecular Templates, Origin Commercial Ventures. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This project was supported by the Association of American Cancer Institutes and its 98 member cancer centers. The Biostatistical Shared Resource of the Case Comprehensive Cancer Center (P30CA37034) provided analytical support.

Correspondence: Stanton L. Gerson, MD, Case Comprehensive Cancer Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Wearn 151, Cleveland, OH 44106. Email: slg5@case.edu
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