Bilimoria Karl Y, Bentrem David J, Stewart Andrew K, Winchester David P, Ko Clifford Y
American College of Surgeons, Division of Research and Optimal Patient Care, 636 N St Clair St, Chicago, IL 60611, USA.
J Clin Oncol. 2009 Sep 1;27(25):4177-81. doi: 10.1200/JCO.2008.21.7018. Epub 2009 Jul 27.
The Commission on Cancer (CoC) designates cancer programs on the basis of the ability to provide a wide range of oncologic services and specialists. All CoC-approved hospitals are required to report their cancer diagnoses to the National Cancer Data Base (NCDB), and the cancer diagnoses at these hospitals account for approximately 70% of all new cancers diagnosed in the United States annually. However, it is unknown how CoC-approved programs compare with non-CoC-approved hospitals.
By using the American Hospital Association Annual Survey Database (2006), CoC-approved and non-CoC-approved hospitals were compared with respect to structural characteristics (ie, accreditations, geography, and oncologic services provided).
Of the 4,850 hospitals identified, 1,412 (29%) were CoC-approved hospitals, and 3,438 (71%) were not CoC-approved hospitals. The proportion of CoC-approved hospitals varied at the state level from 0% in Wyoming to 100% in Delaware. Compared with non-CoC-approved hospitals, CoC-approved programs were more frequently accredited by the Joint Commission, designated as a Comprehensive Cancer Center by the National Cancer Institute, and affiliated with a medical school or residency program (P < .001). CoC-approved hospitals were less likely to be critical access hospitals or located in rural areas (P < .001). CoC-approved hospitals had more total beds and performed more operations per year (P < .001). CoC-approved programs more frequently offered oncology-related services, including screening programs, chemotherapy and radiation therapy services, and hospice/palliative care (P < .001).
Compared with non-CoC-approved hospitals, CoC-approved hospitals were larger, were more frequently located in urban locations, and had more cancer-related services available to patients. Studies that use the NCDB should acknowledge this limitation when relevant.
癌症委员会（CoC）根据提供广泛肿瘤服务和专家的能力来指定癌症项目。所有获得CoC批准的医院都必须向国家癌症数据库（NCDB）报告其癌症诊断情况，这些医院的癌症诊断约占美国每年新诊断癌症总数的70%。然而，尚不清楚获得CoC批准的项目与未获得CoC批准的医院相比情况如何。
通过使用美国医院协会年度调查数据库（2006年），对获得CoC批准和未获得CoC批准的医院在结构特征（即认证、地理位置和提供的肿瘤服务）方面进行了比较。
在确定的4850家医院中，1412家（29%）是获得CoC批准的医院，3438家（71%）是未获得CoC批准的医院。获得CoC批准的医院比例在州一级从怀俄明州的0%到特拉华州的100%不等。与未获得CoC批准的医院相比，获得CoC批准的项目更频繁地获得联合委员会的认证，被国家癌症研究所指定为综合癌症中心，并与医学院或住院医师项目相关联（P < .001）。获得CoC批准的医院不太可能是急救医院或位于农村地区（P < .001）。获得CoC批准的医院总床位数更多，每年进行的手术更多（P < .001）。获得CoC批准的项目更频繁地提供与肿瘤学相关的服务，包括筛查项目、化疗和放疗服务以及临终关怀/姑息治疗（P < .001）。
与未获得CoC批准的医院相比，获得CoC批准的医院规模更大，更频繁地位于城市地区，并且为患者提供更多与癌症相关的服务。使用NCDB的研究在相关时应承认这一局限性。
