Vulnerable patients have a decreased mortality risk when treated at Commission on Cancer-accredited hospitals
Vulnerable patients facing social, environmental, and economic disadvantages often experience worse cancer outcomes than other groups. Some of these disparities may be reduced by increasing access to hospitals accredited by the American College of Surgeons (ACS) Commission on Cancer (CoC), according to a study published in the Journal of the American College of Surgeons (JACS).
The study found that highly vulnerable patients treated at CoC-accredited hospitals, as measured by the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), were more likely to receive care that adhered to national treatment guidelines and were 9% less likely to die than patients treated at non-CoC-accredited hospitals during the study period. These results may be due to CoC-accreditation requirements for treatment guideline adherence, community engagement, and addressing barriers to care, the study authors said.
Key study findings
- Patients with high social vulnerability treated at CoC-accredited hospitals had a 9% reduction in mortality rate compared to those treated at non-CoC-accredited hospitals during the study period.
- Patients treated at CoC-accredited hospitals had a 79% higher likelihood of receiving guideline-concordant care (GCC) compared to those treated at non-CoC-accredited hospitals.
- Patients in the highest SVI quartile had 21% decreased potential of receiving GCC overall.
This retrospective observational study identified 124,950 patients with stage I-III colon cancer (102,399 patients) or stage II-III rectal cancer (22,551 patients) between 2018 and 2020 from the National Program of Cancer Registries Database. Vulnerability was measured using the SVI, which was developed by the CDC and ranks the relative vulnerability of every U.S. census tract or county based on 16 social factors on a composite scale ranging from 0 to 100, with 0 indicating the least vulnerable population and 100 indicating the most vulnerable population.
“Highly vulnerable patients are at an increased risk for late cancer stage at diagnosis, treatment delays, and non-receipt of guideline-concordant care,” said lead author Kelley Chan, MD, MS, a Clinical Scholar in Residence at the ACS Cancer Programs and also a general surgery resident at Loyola University Medical Center. “For example, colorectal cancer survival has been demonstrated to be 30% lower in more deprived neighborhoods.”
Despite the overall decline in the incidence and mortality of colon and rectal cancer, which is likely due to the increase in screening colonoscopies, this rate of decline has not been shared equally, she said. For example, incidence rates are higher in Black patients than in non-Hispanic White patients.
The study found that patients treated at CoC-accredited hospitals had 79% higher likelihood of receiving GCC than those treated at non-CoC-accredited hospitals. Patients in the highest SVI quartile had a 21% decreased chance of receiving GCC but were more likely to receive GCC at a CoC-accredited hospital than at a non-CoC-accredited hospital. The JACS study found that the probability of receiving GCC declined as SVI rose; this decline, however, was faster among patients at non-CoC-accredited hospitals than those at CoC-accredited hospitals, she said.
High SVI patients may be more likely to receive GCC at CoC-accredited hospitals because those hospitals benchmark data and have accreditation requirements to address barriers to care, Dr. Chan said. Research has shown that programs that track adherence to evidence-based quality measures and benchmark their performance with other CoC-accredited hospitals are more likely to have better coordination of multidisciplinary care and better outcomes than hospitals that do not track and benchmark data, she said. The CoC also provides resources to assess community needs and requires accredited hospitals to partner with community organizations to address challenges related to social determinants of health.
