Status of Cancer Care at Network Sites of the Nation's Academic Cancer Centers

Abstract

Background: Cancer care coordination across major academic medical centers and their networks is evolving rapidly, but the spectrum of organizational efforts has not been described. We conducted a mixed-methods survey of leading cancer centers and their networks to document care coordination and identify opportunities to improve geographically dispersed care.

Methods: A mixed-methods survey was sent to 91 cancer centers in the United States and Canada. We analyzed the number and locations of network sites; access to electronic medical records (EMRs); clinical research support and participation at networks; use of patient navigators, care paths, and quality measures; and physician workforce. Responses were collected via Qualtrics software between September 2017 and December 2018.

Results: Of the 69 responding cancer centers, 74% were NCI-designated. Eighty-seven percent of respondents were part of a matrix health system, and 13% were freestanding. Fifty-six reported having network sites. Forty-three respondents use navigators for disease-specific populations, and 24 use them for all patients. Thirty-five respondents use ≥1 types of care path. Fifty-seven percent of networks had complete, integrated access to their main center's EMRs. Thirty-nine respondents said the main center provides funding for clinical research at networks, with 22 reporting the main center provides all funding. Thirty-five said the main center provided pharmacy support at the networks, with 15 indicating the main center provides 100% pharmacy support. Certification program participation varied extensively across networks.

Conclusions: The data show academic cancer centers have extensive involvement in network cancer care, often extending into rural communities. Coordinating care through improved clinical trial access and greater use of patient navigation, care paths, coordinated EMRs, and quality measures is likely to improve patient outcomes. Although it is premature to draw firm conclusions, the survey results are appropriate for mapping next steps and data queries.

Figure 1.

Number of networks reported by each respondent compared with total number of clinical physicians (ie, medical/hematologic oncologists, radiation oncologists, and surgeons) reported at the networks (n=44).

Figure 2.

Availability of patient navigators at the main cancer center and network sites.

Figure 3.

Impact of care paths at the network practice sites.

Figure 4.

Availability of EMRs between main cancer center and network practice sites. Of the 49 respondents who reported network site access to EMRs at the main center, 90% indicated that the network sites had either full or at least partial access to EMRs at the main center. Eighty-three percent of respondents indicated at least partial or full EMR access between network sites, and 88% indicated that the main center had full or partial access to EMRs at the network sites. Abbreviation: EMR, electronic medical record.