Impact of Commission on Cancer Accreditation on Cancer Survival: A Surveillance, Epidemiology, and End Results (SEER) Database Analysis.

Abstract

To analyze the cancer burden in the United States, researchers are relying on the Surveillance, Epidemiology, and End Results (SEER) Program. Our objective was to analyze differences in cancer outcome between Commission on Cancer (CoC)-accredited and non-accredited facilities. The SEER database was queried for diagnosis years 2018 and 2019. Only analytic cases were included. Observed survival was calculated using the Kaplan-Meier method for all cancer sites, stratified by accreditation status. Univariate analyses were performed to quantify differences in survival between cancer cases in CoC-accredited and non-CoC-accredited facilities. Cancers of interest were chosen based on statistical significance (p<0.01) and clinical significance (>25% difference in end survival). Multivariate analyses were conducted on cancers of interest. Overall, there were 602,185 cases from CoC-accredited facilities and 198,492 from non-CoC-accredited facilities. 5 of 59 solid organ cancers showed statistically and clinically significant reductions in survival in non-accredited facilities (lung and bronchus: 27.9%; liver: 41.1%; esophagus: 30.4%; pancreas: 32.7%; intrahepatic bile duct: 39.4%). Multivariate analysis on these 5 cancers was performed. CoC accreditation was a statistically significant variable decreasing the hazard in all 5 cancers (hazard ratio 0.86-0.91; all p-values <0.005). All these cancers demand resource-intensive treatment. Accreditation has a significant impact on survival in 5/59 solid organ cancers. Although accredited facilities may be better apt to handle these cancer cases, the survival in most cancers is not significantly affected by accreditation. However, examining longer-term endpoints elucidate further nuances. Herein, CoC accreditation was found to be an independent variable impacting 2-year survival for a minority of cancers.