为什么卓越癌症中心不一定适合每一位患者-动脉网

Why Cancer Centers of Excellence May Not Be Right for Every Patient

MedCity News 等信源发布 2023-12-15 05:30

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We’ve all been touched by cancer in some way, whether through a personal experience or a loved one’s experience, and we all know how terrifying a diagnosis can be. I’ve spent more than 20 years in oncology, both as a neuro-oncologist treating patients with brain tumors and in the industry, so I know how heavy the burden of cancer is..

无论是个人经历还是亲人的经历，我们都曾在某种程度上被癌症所触动，我们都知道诊断有多可怕。我在肿瘤学领域工作了20多年，无论是作为一名治疗脑肿瘤患者的神经肿瘤学家，还是在这个行业，所以我知道癌症的负担有多重。。

People may find comfort in knowing that they or their loved ones will have access to care at well-known institutions, often called “centers of excellence.” You’re likely familiar with some of the highly renowned centers in the United States, such as Memorial Sloan Kettering Cancer Center, Dana-Farber Cancer Institute, and MD Anderson Cancer Center – and their reputation for providing exceptional care.

人们可能会感到安慰，因为他们或他们的亲人可以在著名的机构获得护理，这些机构通常被称为“卓越中心”。你可能熟悉美国一些非常著名的中心，例如纪念斯隆·凯特琳癌症中心，达纳·法伯癌症研究所，和MD安德森癌症中心-以及他们提供特殊护理的声誉。

Yet, when faced with a cancer diagnosis, traveling in person to one of these institutions is not necessarily the best option for every patient. .

然而，当面临癌症诊断时，亲自前往这些机构之一并不一定是每位患者的最佳选择。

What are cancer centers of excellence?

什么是癌症卓越中心？

Cancer centers of excellence (COEs), like my own alma mater, Dana-Farber Cancer Institute, are large institutions that offer cutting-edge, high-quality cancer treatment. Most are academic centers that are involved in teaching, training, and basic and clinical research in addition to care. They are typically organized around specialty centers for certain types or subtypes of cancer and often have robust clinical trial programs to offer patients the latest innovations in treatment..

与我的母校达纳·法伯癌症研究所一样，癌症卓越中心（COE）是提供尖端，高质量癌症治疗的大型机构。大多数是学术中心，除护理外，还参与教学，培训以及基础和临床研究。他们通常围绕特定类型或亚型癌症的专业中心组织，通常有强大的临床试验计划，为患者提供最新的治疗创新。。

A large and growing number of employers offer COE approaches to give employees with cancer comfort and reassurance, guide them to high-quality care, and ideally improve outcomes. In fact, 53% of employers plan to offer a cancer-focused COE approach in 2024, and an additional 23% plan to consider it by 2026..

越来越多的雇主提供COE方法，为员工提供癌症安慰和保证，引导他们获得高质量的护理，并理想地改善结果。事实上，53%的雇主计划在2024年提供以癌症为中心的COE方法，另外23%的雇主计划在2026年之前考虑。。

When an employer offers a COE approach, it often means they partner with a third-party company that can connect employees with care at National Cancer Institute-Designated Cancer Centers (NCICCs), such as those listed above. While the specific offerings and costs vary, some of these programs encourage employees to travel for care at academic centers as opposed to receiving care in their own communities..

当雇主提供COE方法时，通常意味着他们与第三方公司合作，该公司可以将员工与国家癌症研究所指定的癌症中心（NCICC）的护理联系起来，例如上面列出的那些。虽然具体的服务和费用各不相同，但其中一些计划鼓励员工前往学术中心接受护理，而不是在自己的社区接受护理。。

The programs can be extremely valuable for some patients, but they also have potential downsides. When an employer offers a COE approach, it can create an expectation that, if an employee is diagnosed with cancer, they must go to these centers for care, even if it may not be the best option for them given their particular diagnosis, geographic location, or financial situation..

这些计划对某些患者来说可能非常有价值，但也有潜在的缺点。当雇主提供COE方法时，它可以产生一种期望，即如果员工被诊断出患有癌症，他们必须去这些中心接受护理，即使考虑到他们的特定诊断，地理位置或财务状况，这可能不是他们的最佳选择。。

The value of a community approach to cancer care

社区癌症护理方法的价值

People tend to trust “brand name” institutions, and they may assume that the care at these facilities is better. However, community cancer centers are often more accessible to patients and can provide high-quality and cost-effective care, especially for common types of cancer. Even if a COE is available, patients must not overlook the fact that effective cancer care is often available in their backyards.

人们倾向于信任“名牌”机构，他们可能会认为这些机构的护理更好。然而，社区癌症中心通常更容易为患者提供，并且可以提供高质量和成本效益的护理，特别是对于常见类型的癌症。即使有COE，患者也不能忽视这样一个事实，即在他们的后院通常可以获得有效的癌症护理。

Community-based oncologists have extensive experience treating patients with common types of cancers including breast, colon, prostate, lung, and more, and many offer a limited set of clinical trials..

社区肿瘤学家在治疗常见类型癌症（包括乳腺癌，结肠癌，前列腺癌，肺癌等）患者方面拥有丰富的经验，许多人提供的临床试验有限。。

There are many advantages to receiving care in one’s community, including avoiding the need to travel and find accommodations in a new location, which can be logistically challenging, expensive and stressful. Academic centers are often located in major cities or urban areas, which may be inaccessible for patients in rural or underserved areas..

在社区接受护理有许多好处，包括避免旅行和在新地点寻找住宿的需要，这可能在后勤上具有挑战性，昂贵且压力大。学术中心通常位于大城市或城市地区，农村或服务不足地区的患者可能无法进入。。

Receiving treatment at a COE can present a serious financial obstacle. At COEs, patients typically receive care from specialized oncologists or multidisciplinary teams. While these teams have deep expertise, they may charge higher fees for their services than general oncologists in a patient’s community.

在COE接受治疗可能会带来严重的财务障碍。在COEs，患者通常会接受专业肿瘤学家或多学科团队的护理。虽然这些团队拥有丰富的专业知识，但他们可能比患者社区的普通肿瘤学家收取更高的服务费用。

In addition, COEs often offer advanced diagnostic tests, cutting-edge treatments, and experimental therapies that may be more expensive than standard therapies offered in local settings..

此外，COE通常提供先进的诊断测试，尖端治疗和实验疗法，这些疗法可能比当地提供的标准疗法更昂贵。。

Even for standard therapies, academic centers tend to mark up the prices of drugs significantly more than community centers – sometimes 4x or more. For example, according to a recent AHIP report, the average price of a single treatment of Keytruda, a common cancer therapy, is $2,309 when administered at a local physician office but $10,582 at an academic center hospital.

即使是标准疗法，学术中心也往往比社区中心大幅提高药品价格，有时甚至是4倍或更多。例如，根据AHIP最近的一份报告，一种常见的癌症治疗方法Keytruda的单一治疗平均价格在当地医生办公室为2309美元，而在学术中心医院为10582美元。

Our own data shows that the average reimbursement for pertuzumab/trastuzumab/hyaluronidase, an injectable drug for a common subtype of breast cancer, at community infusion centers is $6,680, but the same treatment when administered at one of the NCICCs referenced above is $26,718 on average. In either case, the treatment is injected under the skin by an oncology nurse over 5-10 minutes..

我们自己的数据显示，在社区输液中心，帕妥珠单抗/曲妥珠单抗/透明质酸酶（一种用于常见乳腺癌亚型的注射药物）的平均报销额为6680美元，但在上述NCICC之一进行相同治疗时，平均为26718美元。无论哪种情况，肿瘤护士都会在5-10分钟内将治疗注射到皮肤下。。

Are there advantages to receiving care at centers of excellence?

在卓越中心接受护理是否有优势？

There are certain cases in which patients are best served at a COE. If a patient has a rare type of cancer, an unusually complex case, a poor or uncertain prognosis, or a complicated multidisciplinary treatment plan, they may benefit from the unique expertise available at academic centers. Patients whose treatment options are limited or wish to participate in clinical trials will often find that the number and variety of clinical trials available are greater in the COE setting..

在某些情况下，COE最好为患者提供服务。如果患者患有罕见类型的癌症，异常复杂的病例，预后不良或不确定，或复杂的多学科治疗计划，他们可能会受益于学术中心提供的独特专业知识。治疗选择有限或希望参与临床试验的患者通常会发现，在COE环境中，可用的临床试验数量和种类更多。。

Some studies have suggested better outcomes at academic centers, but this evidence is controversial. A study published in 2022 found that patients with cervical cancer who received care at NCICCs had a greater survival rate compared to those who received care elsewhere. This study acknowledges that the findings may be due to “structural, organizational, or provider characteristics and differences in patients receiving care at centers with and without NCI designation” – implying that the groups of patients who choose care at COEs are not the same as the patients who choose care in community settings..

一些研究表明，学术中心的结果更好，但这一证据存在争议。2022年发表的一项研究发现，与在其他地方接受治疗的患者相比，在NCICCs接受治疗的宫颈癌患者的生存率更高。这项研究承认，这些发现可能是由于“在有和没有NCI指定的中心接受护理的患者的结构，组织或提供者特征和差异”-这意味着在COE选择护理的患者群体与在社区环境中选择护理的患者群体不相同。。

Studies have found that Medicaid-eligible individuals, older patients, and certain marginalized groups are significantly less likely to seek care at NCICCs. Ultimately, the outcomes at COEs may appear to be better not because they are more effective at treating common types of cancer, but because the patients who go there are different – and may be more likely to have better outcomes to begin with..

研究发现，符合医疗补助条件的个人，老年患者和某些边缘化群体不太可能在NCICC寻求护理。最终，COEs的结果似乎更好，不是因为它们在治疗常见类型的癌症方面更有效，而是因为去那里的患者不同-并且可能更有可能从一开始就有更好的结果。。

What should patients do?

患者应该怎么做？

While academic centers have real advantages in terms of specialized expertise and multidisciplinary care, the outcomes of cancer are influenced by numerous factors, and going to a COE does not guarantee any certain result. For those who believe that the higher cost of care will be worth it, unfortunately, cost does not correlate to outcomes.

虽然学术中心在专业知识和多学科护理方面具有真正的优势，但癌症的结果受到许多因素的影响，而去COE并不能保证任何特定的结果。对于那些认为较高的护理成本值得的人来说，不幸的是，成本与结果并不相关。

A review published in 2020 of studies of the relationship between spending and outcomes in cancer found little or no association between higher spending and better outcomes in the United States..

2020年发表的一篇关于癌症支出与结果之间关系的研究综述发现，在美国，支出增加与结果改善之间几乎没有关联。。

Ultimately, there is no one-size-fits-all approach. The choice between going to an academic center or staying in one’s community should be based on the patient’s individual needs, preferences, and cancer case, and it should involve discussions with healthcare professionals to determine the most appropriate course of treatment.

最终，不存在一刀切的方法。去学术中心还是留在社区之间的选择应基于患者的个人需求，偏好和癌症病例，并应与医疗保健专业人员进行讨论，以确定最合适的治疗方案。

From my years working at Dana-Farber Cancer Institute, I can tell you with full certainty that COEs offer outstanding care and can change patients’ lives. I also know it can be a burden to travel to a major city such as Boston, and I believe many patients could be served just as well in the comfort of their own communities..

从我在达纳法伯癌症研究所工作的这些年，我可以完全肯定地告诉你，COE提供了出色的护理，可以改变患者的生活。我也知道去波士顿这样的大城市旅行可能会成为一种负担，我相信许多患者可以在自己舒适的社区得到同样好的服务。。

The notion that patients are always better off receiving treatment at academic centers is flawed, and when an employer offers a COE approach, it can mislead patients to choose that option when care in their local community may be more sensible. Some of the best COE programs available today are increasingly focused on providing remote second opinions without encouraging travel for care.

认为患者在学术中心接受治疗总是更好的观点是有缺陷的，当雇主提供COE方法时，当当地社区的护理可能更明智时，它可能会误导患者选择这种选择。如今，一些最好的COE项目越来越专注于提供远程第二意见，而不鼓励旅行护理。

These approaches may help bring together the advantages of both community care and subspecialized expertise, meaning that it’s not necessarily all or none and patients do not have to commit entirely to just one care setting..

这些方法可能有助于将社区护理和亚专业专业知识的优势结合在一起，这意味着不一定全部或全部没有，患者不必完全致力于一种护理环境。。

In my own clinical practice, many patients were effectively treated in a collaborative manner in which I played a role in setting the treatment strategy for a rare brain tumor type, while the actual treatment was administered and monitored by a medical oncologist near the patient’s home. Let’s listen to our oncologists, trust our communities, and make informed decisions in order to achieve the outcomes cancer patients deserve..

在我自己的临床实践中，许多患者以合作的方式得到了有效的治疗，我在为一种罕见的脑瘤类型制定治疗策略方面发挥了作用，而实际的治疗是由患者家附近的医学肿瘤学家进行管理和监测的。让我们倾听肿瘤学家的意见，信任我们的社区，做出明智的决定，以实现癌症患者应得的结果。。

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