ArticleAnnals of surgery2012
The role of National Cancer Institute-designated cancer center status: observed variation in surgical care depends on the level of evidence.
Article in Annals of surgery, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
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Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review.Journal of neurotrauma · 2021Pooled it
- Evaluating Academic Productivity of Hematology/Oncology Fellows.Journal of cancer education : the official journal of the American Association for Cancer Education · 2025Article
- Patterns of Referral for Common Cancer Surgery in the United States.Annals of surgical oncology · 2025Article
- Effects of location of primary tumor on survival after pulmonary metastasectomy for colorectal cancer.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025Article
- EndoBridge 2023: highlights and pearls.Hormones (Athens, Greece) · 2024Article
- Health insurance literacy among head and neck cancer patients and their caregivers: A cross-sectional pilot study.Laryngoscope investigative otolaryngology · 2022Article
- Adherence to guidelines at the patient- and hospital-levels is associated with improved overall survival in patients with gastric cancer.Journal of surgical oncology · 2022Article
- A single institution experience with papillary thyroid cancer: Are outcomes better at comprehensive cancer centers?American journal of surgery · 2021Article
- Thyrotropin Suppression for Papillary Thyroid Cancer: A Physician Survey Study.Thyroid : official journal of the American Thyroid Association · 2021Article
- Observational
- Is there value in cancer center accreditation?American journal of surgery · 2020Article
- Understanding Thyroidectomy Cost Variations Among National Cancer Institute-Designated Cancer Centers.World journal of surgery · 2020Article
- Determinants of Rectal Cancer Patients' Decisions on Where to Receive Surgery: a Qualitative Analysis.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2019Article
- Pre-existing autoimmune disease and the risk of immune-related adverse events among patients receiving checkpoint inhibitors for cancer.Cancer immunology, immunotherapy : CII · 2019Article
- Breast Cancer Mortality in Older and Younger Patients in California.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2019Article
- Adherence to postresection colorectal cancer surveillance at National Cancer Institute-designated Comprehensive Cancer Centers.Cancer medicine · 2018Article
- Integration of Massage Therapy in Outpatient Cancer Care.International journal of therapeutic massage & bodywork · 2018Article
- Disparities in Geographic Accessibility of National Cancer Institute Cancer Centers in the United States.Journal of medical systems · 2017Article
- Controversies in the Management of Low-Risk Differentiated Thyroid Cancer.Endocrine reviews · 2017Review
- Variation in Inpatient Croup Management and Outcomes.Pediatrics · 2017Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectiveWe sought to evaluate differences in guideline concordance between National Cancer Institute (NCI)-designated and other centers and determine whether the level of available evidence influences the degree of variation in concordance.
backgroundThe National Cancer Institute recognizes centers of excellence in the advancement of cancer care. These NCI-designated cancer centers have been shown to have better outcomes for cancer surgery; however, little work has compared surgical process measures.
methodsA retrospective cohort study was conducted using Surveillance, Epidemiology and End Results registry linked to Medicare claims data. Fee-for-service Medicare patients with a definitive surgical resection for breast, colon, gastric, rectal, or thyroid cancers diagnosed between 2000 and 2005 were identified. Claims data from 1999 to 2006 were used. Our main outcome measure was guideline concordance at NCI-designated centers compared to other institutions, stratified by level of evidence as graded by National Comprehensive Cancer Network guideline panels.
resultsAll centers achieved at least 90%, and often 95%, concordance with guidelines based on level 1 evidence. Concordance rates for guidelines with lower-level evidence ranged from 30% to 97% and were higher at NCI-designated centers. The adjusted concordance ratios for category 1 guidelines were between 1.02 and 1.08, whereas concordance ratios for guidelines with lower-level evidence ranged from 0.97 to 2.19, primarily favoring NCI-designated centers.
conclusionsWhen strong evidence supports a guideline, there is little variation in practice between NCI-designated centers and other hospitals, suggesting that all are providing appropriate care. Variation in care may exist, however, for guidelines that are based on expert consensus rather than strong evidence. This suggests that future efforts to generate needed evidence on the optimal approach to care may also reduce institutional variation.
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