Impact of care at NCI Comprehensive Cancer Centers (NCICCC) on cancer outcome: Results from a population-based study.

Abstract

188 Background: Despite advances in therapy and supportive care, prognosis for certain cancers remains poor. Rigorous processes ensure quality of research, clinical care and education at NCICCC. However, impact of site of care on survival and access to NCICCC for vulnerable subpopulations (race/ethnicity, payor) remains unstudied. Methods: We constructed a population-based cohort of 53,618 patients diagnosed between 22y-65y with adult-onset cancers and reported to LA County cancer registry between 1998-2008. Geographic Information Systems (ArcGIS) was used for geospatial analysis. Results: Across multiple diagnoses, patients at NCICCC showed superior 5y overall survival (OS) as compared to those at community sites (Breast [n=31,770]: 89% vs. 86%, p<0.01; Lung [n=10,855]: 28% vs. 17%, p<0.01; Hepatobiliary [n=4,296]: 34% vs. 19%, p<0.01; Gastric [n=2,678] 32% vs. 22%, p<0.01; Pancreas [n=2,326]: 13% vs. 6%, p<0.01; Oral [n=1,838]: 68% vs. 59%, p=0.01). Adjusting for clinical (age, stage, gender) and sociodemographic (race/ ethnicity, payor, socioeconomic status [SES]) characteristics, multivariable Cox regression revealed an increased risk of mortality in patients receiving care at non-NCICCC sites: Breast: hazard ratio (HR)=1.2, p<0.01; Lung: HR=1.5, p<0.01; Hepatobiliary: HR=1.4, p<0.01; Gastric: HR=1.4, p<0.01; Pancreas (n=2,326), HR=1.5, p<0.01; Oral: HR=1.3, p=0.05. Overall 7% of patients were seen at NCICCC (range 4-16%, p<0.01). Multivariable logistic regression adjusting for clinical characteristics revealed that low SES (OR range across diagnoses: 0.4-0.5, p<0.01), public (OR 0.4-0.9, p<0.03) or no (OR 0.1-0.7, p<0.04) insurance, African-American race (OR 0.4-0.6, p<0.03) or Hispanic ethnicity (OR 0.5-0.7, p<0.02), and residing > 9 miles from nearest NCICCC (OR 0.5-0.9, p<0.01) decreased likelihood of care at NCICCC. Conclusions: Population-based data reveal superior OS among adult-onset cancer patients receiving care at NCICCC. Patients without private insurance, from low SES, African-American and Hispanic backgrounds or living more than 9 miles from an NCICCC, are less likely to use NCICCC. Barriers to care at NCICCC are currently being explored.