COLUMBUS, Ohio—The Arthur G. James Cancer Hospital and Research Institute at Ohio State University was recently added to the National Comprehensive Cancer Network (NCCN) Oncology Outcomes Database, bringing the total number of medical centers participating in the database to six. The database is currently collecting data on new breast cancer patients and their treatment.
Joining the James in its participation in the outcomes database is Anthem Blue Cross and Blue Shield. Under this partnership, physicians who are unaffiliated with the James but who are providers within the Anthem system will be able to participate in the outcomes database.
This is the first instance in which an NCCN member and a managed care company have formed a direct partnership for participation in the outcomes database. Anthem serves 4 million residents of Ohio, Indiana, and Kentucky.
Anthem physicians will begin to add breast cancer patients to the database in 24 to 30 months, NCCN chief executive officer William McGivney, PhD, told Oncology News International.[ A report on the outcomes database will be featured at the NCCN's fourth annual conference].
Physicians who are affiliated with the James Oncology Network will also be able to add patients to the database, Dr. McGivney said. Affiliate participation will begin in 12 to 15 months, he estimated.
The purpose of the NCCN database is to evaluate how closely physicians are adhering to NCCN guidelines for the treatment of breast cancer and to examine clinical outcomes. “It is critical to implement the guidelines,” Dr. McGivney said. “The most effective way is through performance measurement.”
All new breast cancer patients at participating institutions will be entered into the database. Data collection begins as soon as a patient has a workup for a suspicious lesion. The information collected on a patient—the “data dictionary”—goes beyond staging, Dr. McGivney said. It covers 224 characteristics of the patient and her disease.
Sociodemographic features, such as ethnicity, education, and employment, are among the characteristics entered into the database for each patient. Clinical data are also submitted, including medical history, stage, histology, menopausal status, comorbidity, and treatment details.
Once treatment is completed, information on follow-up treatment and outcome is collected. In addition to traditional outcomes, such as overall and disease-free survival, the database records days in hospital, days lost from work and performance status.
The goal is to deliver “not just good outcomes in the traditional medical sense but also good quality of life,” said Anthem national medical director Derek van Amerongen, MD. To measure patient satisfaction and quality of life, patients are asked to fill out update forms of three or four questions on each of their return visits for treatment.
Managed care companies are in a position to “leverage” the implementation of NCCN guidelines, Dr. van Amerongen said. “This is no mean feat,” he said. “One of the major dilemmas in medicine today is that research findings rarely seem to find their way into the everyday practice of the majority of physicians.”
A major contribution of managed care to medicine has been its ability to “push for decision-making based on data,” Dr. McGivney said. With the outcomes database, physicians will have data available to support their treatment recommendations. This is especially important when physicians are faced with controversy.
Follow-up care after treatment of breast cancer is one example of an area of clinical disagreement, said surgical oncologist William Burak, MD, co-principal investigator for the database project at the James. Studies have questioned the value to survival of early detection of recurrent cancer through chest x-rays and bone scans. “Some standard things we do have never been looked at for effectiveness,” he said. “The outcomes database gives us a chance to do that.”
Dennis Smith, director of administration at the James, anticipated that with the outcomes database, these kinds of clinical controversies will be resolved relatively quickly, “in a couple of years, not 10 years out.”
The NCCN expects to have all of its members that treat breast cancer patients involved in the project by June 1999, at which time approximately 1,000 new breast cancer patients will be added to the database each quarter.
