90% of cancer patients are treated at community hospitals, and some may be a Comprehensive Cancer Center or Cancer Center having top doctors, state of the art technology. Any place can be called a CCC or CC for that matter. There is no trademark, qualifications or restrictions for its use. There are ones designated by NCI, and NCCN, and as Christine mentioned, not all are equal. As far as NCI, some may have qualified for one cancer, but not all, and it has do more with grant money, meeting other qualifications, and not the outcome of any cancer treatment. and some may have even used their clout to get a designation. Then there is the listing themselves, there are 26 or so NCCN designations, and almost 50 on the NCI approved list, maybe I have it backwards, but about 25 are not on both listings or more, although some may just do research, but otherwise, why? I guess you have to look further if it truly is a CCC or CC, how obtained, patient outcome, who they really serve, and probably goes deeper than just a CCC or CC designation. Also, I was treated at two large high volume world renowned CCC for HNC, one community hospital, none which are on the NCI or NCCN listing, and see some other top rate CCC in NYC that aren't either, then some unheard centers are...makes you wonder?

Not to be stubborn, but I still have a great deal of disquiet about blind faith in CCCs. Christine, you very kindly provided links to two news articles about outcomes at various institutions. I tracked down abstracts for those studies (couldn't get the full studies), and I don't read them as endorsing CCCs. Neither study abstract mentions CCCs, and neither concludes that CCCs are superior or more likely to follow NCCN guidelines.

http://onlinelibrary.wiley.com/doi/10.1002/cncr.27976/abstract
Concludes that for HNC patients older than 66, high-volume hospitals provided nearly statistically significant gains in survival and that both high- and low-volume hospitals followed NCCN guidelines.

http://oto.sagepub.com/content/147/6/1083.abstract
Concluded that HNC survival rates are higher in academic institutions.

I'm guessing that these may not be the studies you had in mind -- Or is there something I'm missing here?

Please understand, I'm not anti-CCC; I just don't think any doc at any CCC is automatically better. My own experience is that choosing a CCC isn't enough:

-- It's essential to get at least one second opinion from another CCC or high-volume academic institution. There are major controversies in HNC treatment, particularly for HPV+, and the best docs can have widely varying perspectives.

-- No matter where you go, you should also choose the best doctors. Do your research before you call so that you can request the best doctors by name. Even CCCs have some docs who are stronger than others. Ask your GP, ENT or medically connected friends to recommend the top docs. Look at each docs publications -- Do they publish? Does his/her research show a predominant and recent interest in HNC? Do any of their publications concern your particular HNC? Is the doc in a leadership role at his/her institution or in national medical groups? All are signs that the doc is at the top of his/her field.

I think it's great to consult a CCC if at all possible, but I don't think people should rely solely on the CCC designation. Just my two cents --

I would like to be seen at an institution where they have the most modern equipment (means they can pay for it), they hire the best of the best (they can pay the best salaries), and where the are doing clinical trials (not everyone gets to play in this game, and if so not in most trials related to our area of interest), where they see the largest patient volumes, (they have the most experience, have seen the most complications and are better prepared for when something doesn't go as planned, as they have seen that something a hundred times before), and are rated well by an independent source like the US News and World Reports annual survey which looks at many more criteria than I have mentioned here. By and large a small community hospital on more than one of these points can't offer the same as a big teaching institution that is a NCI designated CCC. This isn't my opinion alone. The hospital ranking system uses these same criteria, including which I didn't add, survival rates, doctors education, number of doctors per patient, number of nurses per patient, and affiliated ancillary staff such as a dedicated dental oncology department with in the H&N department.

Top ranked cancer hospitals in the US by an independent surveyor.

http://health.usnews.com/best-hospitals/rankings/cancer

How this survey is conducted and using what benchmarks

http://health.usnews.com/health-new...ranked-the-best-hospitals-2013-14-an-faq

Often times we justify our actions based on less than completely objective criteria or lack of fully exploring all options. For many reasons, I submit researching and selecting cancer providers may well be given less time than selecting a new car.

There has been ongoing discussion and debate about receiving the best outcomes for HNC patients from the many provider options: local, regional, and national. Most focus has been on local vs national and not much discussion on metro/regional options.

Many of us live in or close proximity to metro/regionally ranked facilities and wonder how much we give up by selecting a regional facility due to location and access, time, etc. In other words finding a balance between good outcomes and managing many months of numerous short and long trips for service.

Over the years I have worked very hard to quit second guessing decisions and this applies to all my cancer decisions. That said, I still revisit past decisions not to do the woulda coulda shoulda thing but just to assess the pluses/minuses of my decision.

Maybe living in the SF Bay Area is an unearned luxury as it seems there is an abundance of excellent national and regional choices for cancer. I did not have the luxury of having a blank check nor the time to really assess my options so maybe more by dumb luck and circumstance the providers who have and are treating me turned up in the top metro/regional rankings.

http://health.usnews.com/best-hospitals/area/san-francisco-ca
http://health.usnews.com/best-hospitals/area/san-jose-ca
http://health.usnews.com/best-hospitals/area/sacramento-ca

What I wonder and maybe others facing similar choices would like to better understand is at what point do the differences become small enough that other factors can lead to a regional vs national selection?

I know this is a repetitive post but having been treated at a CCC (Johns Hopkins), I can attest for the level of care I received. Fortunately, I didn't have to look too far away. The US News report, the fact that a friend was successfully treated there and the credentials of my team was enough to know I had selected a Cadillac as cancer hospitals go (insurance covered it too).

However I agree with Mamacita that we shouldn't just "blindly" decide to be treated at a CCC just because it is a CCC. You still have to check out the team and feel comfortable and confident in them. I also agree that a teaching facility is a plus as they will attract some of the brightest and best.

My decision was made even easier based on my negative experience locally. Also, what made my decision easier was the fact that my ENT/Surgeon and RO treated my friend's BOT cancer. He is a musician as well and they saved his life. He's 2 years NED, performing/singing again and doing fine. Finally, upon researching my team members, I found them to be some of the brightest and best in their fields.

IMO, one aspect that is vital regardless of the facility is the "team" approach. CCCs, to best of my knowledge use the "team" approach and the team then consults with a tumor board where even more experts discuss your case. Knowing my team were in constant contact with each other concerning my case was quite comforting. My experience locally was the complete opposite.

Bottom line, I definitely agree with going to a CCC but it doesn't mean you cannot be treated with the same level of success any elsewhere. Ultimately, it comes down to logistics, insurance, financial consideration, confidence in your doctors and your own gut feeling.

"T"

Here is an article that may be helpful from the Journal of Clinical Oncology, "Understanding Cancer Centers."

http://jco.ascopubs.org/content/20/23/4503.full.pdf

Great article, Paul. It really peeks under the cover the medical institutions and reveals just the tip of the iceberg of the realities of what and how and who is organizing and operating the facilities as well as the agendas naturally inherent in any organization.

[quote]Well over 90% of cancer care is provided in community settings[/quote]
If in fact this quote is true then it is desirable the forum temper its zealousness over NCI designated CCC and offer comfort to the vast majority of patients who receive treatment at regional-local facilities.

It is wonderful when one has the opportunity and ability to take advantage of services at a CCC but comfort should be offered to the 90% who find service elsewhere for many different reasons.

Thanks, Don. I thought it was interesting also.