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Putting A Price Tag On The Chase For Cancer-Fighting Excellence

File photo by Mike Sherry
Heartland Health Monitor
The University of Kansas Cancer Center stretches across a variety of locations, with its headquarters at the University of Kansas Medical Center in Kansas City, Kansas.

Over a span of a dozen years, the University of Kansas Cancer Center estimates that philanthropists, taxpayers and other funders will plow about $1.3 billion into its effort to become one of the nation’s most elite cancer-fighting institutions.

In fact, nearly half that sum is already out the door, spent mostly in the run-up to the 2012 announcement that the KU Cancer Center had become the only institution within hundreds of miles to earn recognition through the National Cancer Institute (NCI).

The rest, according to five-year projections through 2018, would go toward elevating the KU Cancer Center into the upper echelons of NCI-designated centers by earning it “comprehensive” status.

The cancer center’s methodical march toward that goal – benchmarked all the way down to the specific application date of Sept. 26, 2016 – comes amid a rapidly shifting cancer market in the Kansas City area. Yet measured purely in breadth and depth, the cancer center’s effort is arguably the biggest of all the moving parts among oncology providers in the region.

Of the 68 NCI-designated centers around the country, three in five have earned “comprehensive” status, meaning that they have enhanced their clinical and research capabilities in addition to demonstrating their ability to reduce cancer prevalence in their service areas.

Of the four NCI-designated centers within the four-state region, including KU Cancer Center, two have earned comprehensive status: Holden Comprehensive Cancer Center in Iowa City, Iowa, and the Alvin J. Siteman Cancer Center in St. Louis. The fourth is the Fred and Pamela Buffett Cancer Center in Omaha, Neb.

In its initial application to NCI, the KU Cancer Center said recognition from the institute was “a key metric for providing external validation of excellence in cancer research.”

But, it added, that recognition is just a means toward the end of driving “a measurable reduction in the burden of cancer for our patients, their families, our state, our region and our nation.”

Getting here

KU Cancer Center officials say the university’s interest in pursuing NCI recognition goes back several decades. But they credit Dr. Barbara Atkinson with resurrecting the idea upon her appointment as dean of the KU School of Medicine in 2002. She retired three years ago.

Dr. Roy A. Jensen’s arrival in 2004 from Vanderbilt University quickened the march toward NCI designation. Since then, the pace has not slowed. Between 2010 and the end of last year, the organization’s expansion has included:

  • A 40 percent increase in the value of research projects under its umbrella, to $69.3 million;
  • A footprint that grew by about 21 percent to 485,000 square feet of space; and
  • An 8 percent increase in its annual operating budget, to $16.3 million

The application for NCI recognition is technically a request for a Cancer Center Support Grant (CCSG) through the NCI. Similarly, the cancer center’s effort to obtain the higher status of a “comprehensive” in two years is an application to renew the grant.
In all, the CCSG grant has provided $4.3 million since the KU Cancer Center earned NCI-designation in July 2012. But the grant provides only a fraction of KUCC’s overall operating budget.

In 2014, it made up about 7 percent, or $1.1 million, of the cancer center’s $16.3 million operating budget. By contrast, the state’s appropriation of $5 million — provided annually since 2007 — made up nearly a third of its annual budget.

With 173 researchers spread across dozens of departments, the KU Cancer Center operates as what administrators call a “matrix organization,” which includes KU’s Lawrence campus and the Stowers Institute for Medical Research in Kansas City, Mo.

The cancer center also encompasses the clinical trials building in Fairway, Kan., and the Richard and the Annette Bloch Cancer Care Pavilion in Westwood, Kan. Its administrative offices are at the University of Kansas Medical Center.

  Prove it

KU Cancer Center officials contend that the financial benefits of the center ripple far and wide. They estimate that the region will double its $1.3 billion investment through additional economic activity and that the spending will create nearly 3,700 jobs.

Counting state dollars alone, the cancer center calculates it has provided a 14-1 return on investment for Kansas taxpayers.

On the research side, the cancer center points to a variety of projects, including one suggesting a repurposed ovarian cancer drug could treat advanced peritoneal cancers and another that received $1.5 million in federal funds to examine the effectiveness of long-term replacement therapy for patients with chronic obstructive pulmonary disease.

But gauging the extent to which the center’s quest for comprehensive status has yielded a measurable return is easier said than done. Should it be measured by research breakthroughs? Or should it be measured by economic impact? Or are patient outcomes the appropriate standard?

KU Cancer Center officials say it’s all of the above — plus something else: the culture of excellence that comes with the vast research and clinical wherewithal of an NCI-designated center. 

“That is a very powerful force for driving quality, and no other institution, other than an NCI-designated center, really has the capability, the resources, the manpower, the expertise to drive that … and we constantly have to measure ourselves against the best in the country and the best in the world,” says Jensen, director of the KU Cancer Center.

That self-appraisal notwithstanding, some skeptics question the cancer center’s oft-cited assertion that patient outcomes at NCI-designated centers are 25 percent better than at other clinics.

“And everything you read on the Internet is true,” says Dr. Tim Pluard, director of the Saint Luke’s Cancer Institute, which has overlapping clinical interests with the KU Cancer Center in the Northland.

Officials with HCA Health Midwest, a large system based in Kansas City, Mo., contend that their company, not the KU Cancer Center, leads the pack when it comes to the number of clinical trials it can offer patients.

HCA offers oncology care “because we feel like we can do it better than anyone else,” says John Myers, the system’s regional vice president of cancer services.

In making their case about patient outcomes, cancer center officials cite a paper by the Dartmouth Institute for Health Policy and Clinical Practice, which was published in October 2009 in the Medical Care Research Review.

Using 1998-2002 data from the National Cancer Institute and Medicare, the study compared mortality rates among patients with lung, breast, colon/rectum or prostate cancer. The paper did report that the one-year mortality rate among patients in the study was about 25 percent better for people treated at NCI-designated centers than people treated elsewhere. It found a somewhat less strong correlation in three-year survivability.

Yet observers like Pluard question the relevance of the study, since it is now nearly six years old. Given the rapidly evolving landscape of oncology, he says a study that old “is not really going to be that informative to what’s happening at the present time.”

Jensen counters that the study included tens of thousands of patients in different regions and treatment centers. “It’s as good as information as you can possibly get,” he insists.

Other observers question how meaningful metrics like survivability and mortality are in determining the best places for oncology services.

In a paper published last year in the Journal of Oncology Practice, Paul Goldberg and Rena Conti found that the types of comparative studies used to produce report-card-type findings defy even the most conscientious efforts to eliminate potential selection bias. They noted that confounding variables in outpatient oncology include the stage of the cancer, types of therapy and co-occurring conditions.

Meanwhile, according to the paper, consolidation of services among independent practices, hospitals and health systems makes it increasingly difficult to identify unique providers.

Conti is an assistant professor of health policy at the University of Chicago. Goldberg is editor of The Cancer Letter, an independent weekly newsletter that covers research, funding, legislation and policy.

In a phone interview, Goldberg said patients are probably better off at NCI-designated centers because of the scientific and clinical prowess they can bring to bear. But, he said, there are no reliable metrics to prove that theory.

“It’s almost like believing in God,” he said. “Some people do; some people don’t.”

Yet Jensen is no agnostic when it comes to believing in the Dartmouth study and in the ability of institutions like his to provide the best treatment anywhere.

With such big staffs and large numbers of patients, he said, NCI-designated centers can devote substantial resources to specific manifestations of the disease.

Citing one example, Jensen noted that the KU Cancer Center has an entire team dedicated solely to breast cancer, including support staff like patient navigators.

“That is all they treat, and so they can keep up on the latest research, they can know what the best trials are out there, and they are in position to quickly adapt as advances are made in the field,” he said. “So the focus is always on the cutting edge and what is the latest, greatest, standard of practice in the field.”

Mike Sherry is a reporter for KCPT television in Kansas City, Mo., a partner in the Heartland Health Monitor team.

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