These public reports raise all boats. For example, studies have proven that when surgeons remove and pathologists examine at least 12 regional lymph nodes, colon cancer patients have better survival rates because their disease is more accurately identified and staged, and thus, more appropriately treated.
When the commission launched that measure a few years ago, McKellar says, a mere 54% of cancer programs were evaluating all 12 nodes. Now, with a few years of reporting to the CoC, national program compliance is at 87%.
In Pennsylvania, hospitals that have work to do on this measure now know who they are, and so do their patients and payers. After all, cancer is expensive. One in every 10 federal dollars, primarily from Medicare, is spent on cancer screenings and treatment.
For example, on the 12-node measure, Crozer-Chester Medical Center in Upland, PA, scores only 48%, compared with Delaware County Memorial Hospital in Drexel Hill, only 10 miles away, which scored 100%. The pressure to improve is that much more intense.
An expert in socioeconomic and racial care disparities, Brawley notes that "our hospitals have really failed us" by not adhering to such cancer quality benchmarks for poor people as they do for wealthier patients.
"The pathologists in certain very large, very busy hospitals overrun with large numbers of poor people were resecting only two or three or four nodes from a colon cancer specimen," he says. "You would end up with a large number of patients being staged differently than they should be, and not treated appropriately."