MSK Study Examines Cancer-Care Outcomes among US Hospitals

By Jim Stallard,

Thursday, October 8, 2015


Research shows that cancer survival outcomes can vary widely depending on where patients receive care. However, it has been difficult to assess hospitals by long-term survival rates without including information about cancer stage. A new study by MSK researchers finds that readily available, unbiased Medicare claims data may be sufficient to calculate long-term survival rates at hospitals without the need for cancer stage of individual patients.

  • Cancer care disparities exist among hospitals.
  • It has been difficult to assess hospitals without tumor stage information.
  • A new study suggests tumor stage information may not be needed.
  • This could be a first step toward improving cancer care at all hospitals. 

Decades of research have shown that significant disparities in cancer care exist based on where patients are treated. In particular, people who receive care at hospitals that specialize in cancer and treat a large number of cases have better long-term survival rates.

At the same time, there has been uncertainty about what these differences actually mean. Traditional methods of assessing hospital performance have often relied on data that is not comprehensive and leaves room for doubts about whether certain complicating factors — such as the stage of patients’ tumors — make it difficult to draw valid conclusions when comparing outcomes.

Now a new study by Memorial Sloan Kettering researchers suggests that hospitals’ long-term survival outcomes for cancer patients can be assessed without data on tumor stage, by using readily available, unbiased Medicare claims data. The study, reported online October 8 in JAMA Oncology, could be a critical step toward ultimately improving patient care nationwide.

“Patients need reliable information about hospitals’ survival rates so they can make informed choices about their care,” says David Pfister,  Chief of MSK’s Head and Neck Oncology Service and lead author of the study. “But similarly important, measuring the differences in survival rates among hospitals is a first step toward improving cancer care at every hospital across the country.”

Measuring differences in survival rates among hospitals is a first step toward improving cancer care.
David G. Pfister
David G. Pfister Chief, Head and Neck Oncology Service

Limitations of Conventional Measurement

Survival rates for cancer patients can be readily ascertained from Medicare claims data, which relates to treatments that patients receive over the course of their care. But researchers have hesitated to rely solely on this data when comparing patient outcomes.

The reason for this has to do with the risk-adjustment process researchers use to account for variation in outcomes that is related more to the types of patients they treat — such as those with more advanced disease — than true differences in the quality of care they receive. In cancer, the concern has been that standard risk adjustment could not be adequately accomplished without information on each patient’s cancer stage.

A hospital with a large share of patients with advanced-stage tumors, for example, could have a lower survival rate than a hospital with a greater proportion of patients with less-advanced disease — even though the two hospitals provide equally good care.

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The Tumor Stage Test

For the JAMA Oncology study, the MSK researchers analyzed two parallel data sets: fee-for-service Medicare claims from across the United States, which do not include information on cancer stage; and the Surveillance, Epidemiology, and End Results (SEER) Medicare database, which does include that information. The claims data covered the entire spectrum of inpatient and outpatient cancer care, including office visits, chemotherapy, radiation, and even home care.

The researchers calculated the risk-adjusted probability of death over three years and five years for four major cancer types — lung, prostate, breast, and colon — as well as for an “other” category, broken out by the type of hospital providing care. Each patient was assigned to a single hospital where they received care, and the hospitals were categorized into four types:

  • PPS-exempt, which are freestanding cancer hospitals that are exempt from the Medicare prospective payment system
  • National Cancer Institute–designated cancer centers that are not PPS-exempt
  • Academic Medical Centers, or AMCs, which are other academic teaching hospitals
  • other category, which included community hospitals
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Including Tumor Stage Did Not Change Hospital Status

The MSK researchers analyzed risk-adjusted Medicare data both with and without tumor stage information and found that the disease stage had no effect on outcomes from individual hospitals. The results showed that hospital standing based on survival outcomes remained stable, providing strong evidence that incorporating tumor stage information is not essential for accurate assessment.

Findings showed that patients treated at the 11 PPS-exempt hospitals had a 10 percent lower chance of dying in the first year than patients treated at other non-teaching hospitals (18 percent versus 28 percent), with NCI cancer centers and AMCs falling between the two extremes.

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Implications for Public Health

The findings have significant long-term implications for public health. The authors believe acknowledging that significant survival differences do exist among hospitals is an important first step in improving outcomes and worthy of deeper exploration.

“This observed one-year survival gap of 10 percent between hospital types is substantial and represents potentially preventable deaths of cancer patients,” says Peter Bach, director of MSK’s Center for Health Policy & Outcomes and senior author of the paper.

“If further research confirms this survival gap, a next step would be to figure out the mechanics underpinning it,” he adds. “Is it due to readmissions or mortality rates after surgery? Are people having severe side effects keeping them from finishing the chemotherapy that benefits them? We need to break down the data and figure out where the gaps in care exist.”


We need to break down the data and figure out where the gaps in care exist.
Peter B. Bach
Peter B. Bach Director, Center for Health Policy and Outcomes

Similar outcomes research using only administrative claims data is already under way nationally in cardiovascular disease. For example, the Centers for Medicare and Medicaid Services publish risk-adjusted cardiovascular disease mortality rates for US hospitals.

“We hope to eventually do the same thing in cancer,” Dr. Bach says. “More validation is needed of the risk adjustment metrics for hospitals, but I think we can certainly challenge the idea that we need patient-level data on cancer stage to evaluate hospitals.” 

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In addition to Drs. Pfister and Bach, the MSK study was conducted by a multidisciplinary clinical and administrative team including Elaine Duck, Elena Elkin, Ushma Neill, Mark Radzyner, and David Rubin. 


Has any of your specialists come across patients that have been told that they cannot type and stage their B-cell Lymphoma with out the one/only lymph node (next to portal vein & pancreatic head) grows large enough to safely obtain a surgical biopsy?? If so, how have your specialists dealt with proceeding to the point of treatment? I am interested in any information and suggestions you can give. Thank you, in advance.

It's best if you discuss these questions directly with one of our specialists, who can fully evaluate your situation and make a more personalized recommendation regarding possible next steps and treatment options. If you would like to make an appointment, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out.

my 30 year old daughter was just told she might have hodgkins

Cheryl, thank you for reaching out. It is important that your daughter get an accurate diagnosis in order to receive the correct treatment, if needed.

Today, most people with Hodgkin lymphoma (Hodgkin’s disease) can be cured. You can learn more about the treatment of Hodgkin lymphoma at Memorial Sloan Kettering here:…

If you would like to make an appointment with a Memorial Sloan Kettering physician for a consultation, please call our Physician Referral Service at
800-525-2225 or go to Thanks for your comment.

Knowing this study was published and being a current patient who is being forced out of MSK for ongoing follow up care because the hospital hasn't negotiated contracts with insurance companies for individuals or small groups has me here shaking my head. To tout outcomes and then to be forced to put together 9 years of records and assemble a new team feels a bit disingenuous. To be fair, there is one carrier, but it's just one and they've managed to play with their drug formulary in such a way that the costs are prohibitive. Why is Emblem okay for large groups but not for small groups? Why is Magna Care accepted for group policies but not for individual policies? And, I'm not even talking about exchange policies....... Surely MSKCC can find a way to negotiate with Emblem and Magna Care so there are options for small businesses and individuals. The Health Republic insureds are being kicked to the curb. Make this right for more than the 114 patients in active treatment.

Anne Marie, we understand your concern about this issue. If you have not done so, we suggest you contact Memorial Sloan Kettering’s Patient Financial Services department at 212-639-3810 to discuss this. You can see more information here:

My patient has been diagnosed with synovial cell sarcoma, she is foreign exchange student, she has no health insurance in the states, what options does she have for treatment at sloan, she has no financial resources.

Is there any data for foreign hospitals. My friend has pancreatic cancer and has received some palliative care (a drainage tube) from the top Manila hospital. She is trying to decide whether a 26 hour flight to New York would substantially increase her chances.

Andrea, thank you for reaching out. We are unable to assess care given in the hospital she is being treated, but if your friend is interested in having her records reviewed and then possibly coming to Memorial Sloan Kettering for a consultation, she can contact our International Center by calling 1­-212­-639­-4900 or going to­care/international­patients. The email address is

I put this comment in before but it has not appeared. My apologies if it is merely a time delay and it now appears twice.

Is there any data for foreign hospitals. My friend has pancreatic cancer and is deciding whether to be treated by the top hospital in Manila or to make the 26 hour plane trip to New York. This would only be worthwhile if there is a realistic possibility of a better outcome.

Dear Andrea, MSK offers the opportunity for patients who live outside of the US to have their medical records reviewed by mail. If your friend is interested in arranging for a review by mail, or making an appointment for an in-person consultation, please ask him or her to contact our International Center at The staff there may also be able to answer questions about foreign hospitals for cancer care. To learn more about our services for international patients, please visit Thank you for reaching out to us.

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