13 Major Cancer Centers Forge National Alliance

Thirteen of the leading cancer centers in the United States have formed a national alliance, called the National Comprehensive Cancer Network (NCCN), that will develop and institute standards of care for the treatment of cancer and perform outcomes research. The goal of the NCCN is to ensure the delivery of high-quality, cost-effective services to cancer patients across the country. Over the long term, the NCCN will focus efforts on developing programs for large employers and third-party payors that will provide prevention services and cancer care for individuals.

At present, the NCCN consists of 13 institutions, but plans call for enlargement of the network to possibly 30 to 40 institutions in the future. Charter members of the alliance are: City of Hope National Medical Center, Dana-Farber Cancer Institute, Fox Chase Cancer Center, Fred Hutchinson Cancer Research Center, M.D. Anderson Cancer Center, Johns Hopkins Oncology Center, Memorial Sloan-Kettering Cancer Center, Northwestern University/Lurie Cancer Center, Ohio State University Comprehensive Cancer Center/Arthur G. James Cancer Hospital and Research Institute, St. Jude Children's Research Hospital, Stanford University Medical Center, University of Michigan Comprehensive Cancer Center, and University of Nebraska Medical Center.

Rationale for a National Network

Although the 13 institutions have collaborated in the past on research projects, it is the first time that they have participated in a joint business venture, noted Dr. Joseph Simone, Medical Director of the NCCN, at a press conference held in New York on January 31, 1995, to announce formation of the network. The member institutions have come together to set national standards for quality of and access to care, said Dr. Simone, who is Physician-in-Chief at Memorial Sloan-Kettering. "Also, we want to develop and pool our resources so we can jointly learn about medical outcomes...not just for the small population of patients who receive research-directed interventions in our institutions, but for patients who receive care across the entire spectrum of cancer," he added.

While asserting that the purpose of the alliance is not to tell other centers how they should be treating cancer patients, Dr. Simone did concede, in answer to a query from the floor, that many people may well view the consensus standards of care formulated by the alliance as the "gold standard" of cancer treatments. These standards will, however, be constantly changing as new knowledge and experience accrues, Dr. Simone said.

Each of the charter members has agreed to invest $135,000 annually in the NCCN for the next 3 years. More important than this financial commitment, according to Dr. Simone, however, is the "sweat equity" these institutions will provide.

Reaching Into Local Communities

All 13 NCCN participants are in the process of developing partnerships with community hospitals and oncologists practicing in their respective geographical regions. "Network development, which will help to assure quality care at the community level, is an active and vital part of NCCN," commented Dr. Steven Rosen, Director of the Robert H. Lurie Cancer Center at Northwestern University. Characterizing the cancer centers' efforts in this area as critical to the success of the NCCN, Dr. Rosen underscored the member institutions' commitment to establishing "productive, long-term relationships " with local hospitals and physicians providing cancer care. These local relationships "will add to NCCN's reach and scope while enhancing services and standards in the community," he added.

Common Standards

Also speaking at the press conference, Dr. Charles Balch of M.D. Anderson Cancer Center said that the 13 institutions have pledged to maintain the following three common elements in the new network:

Common standards of high-quality cancer care

Standard outcomes reporting

Standard pricing structures for cancer services

Because of the geographical distribution of the network's cancer centers, patients will not have to travel far to receive appropriate care, remarked Dr. Balch, who is Executive Vice President for Health Affairs at M.D. Anderson. The formation of NCCN will afford patients greater flexibility, in that they will be able to receive care in any city that has an NCCN-affiliated institution. "Thus, patients, especially those with complex or unusual forms of cancer, will not have to travel from one end of the country to another in order to gain consultation or delivery of highly specialized services," said Dr. Balch. Patients also will have access to clinical research protocols from among all 13 institutions.

"Rational delivery of cancer care to a geographically diverse group of patients will require that we establish a common set of treatment guidelines," Dr. Balch asserted. Standards of care are already under development in such areas as bone marrow transplantation, pediatric cancer, leukemia, and breast and colon cancer. According to Dr. Simone, most of these guidelines will be completed within the next 6 to 12 months.

Turning the discussion to the issue of cost, Dr. Robert Young, President of Fox Chase Cancer Center, conceded that academic medical centers are often viewed as more expensive than community hospitals. "We expect that the NCCN may provide for the first time, the information needed to make the critical distinction between what is merely cheaper on a per diem basis and what is truly cost-effective care throughout the course of the disease," he remarked.

More Accurate Cost Data

Dr. Young noted that up to now, basically the only way to measure cost-effectiveness has been to determine the cost of care per day or per admission. "It is becoming increasingly evident, however, that this is an inadequate and inaccurate basis for understanding the true costs of managing a complex disease such as cancer throughout the course of treatment," he asserted. "The NCCN will allow the premier cancer centers in the country to pool their resources and combine their expertise to develop optimal standards of care, and then to measure both the clinical effectiveness and the cost-effectiveness of these treatment approaches as they are applied to large patient populations. The NCCN offers payors a unique opportunity to assure their employees or subscribers absolutely top quality cancer care at reasonable prices in the best location and to obtain the necessary information to make valid judgments about how best to spend their dollars."

According to Dr. Simone, NCCN members "believe that collaboration is essential if we are to guarantee availability of high-quality services in a changing health care environment." He continued, "We are not going to wait for health care reform legislation at the national level. Our priority is to be a voice for the patient for what the standard of care ought to be because we believe that the right treatment at the time of diagnosis provides the best outcome and also is the most cost effective."

Statement of Principles

The National Comprehensive Cancer Network is an alliance of cancer-care providers who have joined together to develop and implement standards and guidelines that will assure high quality, cost-effective care. As outstanding cancer centers, they will also join with other institutions, including hospitals and freestanding clinics, and community-based physicians to ensure national access to superior cancer care.

Network members are capable of delivering a full continuum of cancer care. Cancer is unique because it is a complex disease that requires accurate diagnosis and treatment directed by a specialist. Moreover, the multidisciplinary nature of cancer treatment requires that patient care be systematically managed from diagnosis through completion of treatment-a departure from the traditional, compartmentalized approach.

Network members will meet the needs of employers and insurers to better predict costs while providing access to the best possible care. Established clinical guidelines, updated to reflect the most recent clinical and scientific findings, will form the foundation upon which patient care is based. Clinical research with state-of-the-art protocols will be available through Network providers consistent with treatment guidelines that promote cost-effective care. The Network is dedicated to assisting members to deliver cost-effective, high-quality care by:

Developing state-of-the-art practice standards with realistic outcome expectations;

Promoting cost containment and quality-assurance programs;

Advocating the best care through education of consumers, payers and providers about the role of research-based cancer centers in the care, treatment, and cure of patients with cancer;

Facilitating communications and contracting among member institutions and payers;

Assuring a high level of patient and payer satisfaction;

Promoting programs that focus on cancer prevention, early diagnosis, and screening.