Cancer Survival at a Comprehensive Cancer Center Compared with Surveillance, Epidemiology, and End Results (SEER) Estimates

Background

Cancer Centers offer a comprehensive approach to cancer prevention, diagnosis, and treatment through tertiary services and by providing coordinated, personalized care. We investigated whether this approach results in significantly better patient outcomes at an NCI-designated Comprehensive Cancer Center (NCI-CCC), City of Hope (COH), versus the U.S. Surveillance, Epidemiology, and End Results (SEER) national database.

Methods

Patient-level data were abstracted from the COH Cancer Registry and SEER*Stat software, respectively. The cohort included patients diagnosed with incident cancer from 2004 to 2020. Overall survival was analyzed using multivariable Cox proportional hazards models. To reduce confounding from baseline differences, propensity score matching (PSM) methods were employed in a 1:5 ratio between COH and SEER, respectively, using age group at diagnosis category, gender, race, ethnicity, stage (for solid tumors), and diagnosis year.

Findings

Patients treated at COH had significantly superior overall survival (OS) compared with those in the SEER cohort across all examined cancer types after multivariable adjustment for key baseline characteristics and in the PSM analyses. Median OS (when reached) was uniformly longer in the COH cohort compared with the SEER cohort in the full population adjusted model and in the PSM analyses. For the PSM analyses: non-small cell lung cancer (NSCLC) hazard ratio (HR) 0.73 (95% confidence interval [CI]: 0.70-0.76), breast cancer HR 0.83 (95% CI: 0.78-0.86), prostate cancer HR 0.62 (95% CI: 0.58-0.65), colorectal cancer HR 0.74 (95% CI: 0.69-0.79), pancreatic cancer HR 0.75 (95% CI: 0.70-0.81), acute myeloid leukemia HR 0.79 (95% CI: 0.75-0.84), acute lymphoid leukemia HR 0.7 (95% CI: 0.69-0.87), and multiple myeloma HR 0.70 (95% CI: 0.66-0.76) (all p <0.001). In addition, notable findings included substantially lower mortality risk for patients with any of the studied advanced solid cancers, including stage IV NSCLC (HR 0.71, 95% CI: 0.67-0.75, p <0.001) and stage IV breast cancer (HR 0.78, 95% CI: 0.69-0.87, p <0.001).

Conclusions

Our results revealed patient care at an individual NCI-CCC employing state-of-the-art therapies and modern care is associated with survival benefits for cancer patients. Patients had significantly superior OS in the COH cohort compared with the SEER cohort for most of the analyzed solid tumors assessed for each stage (I–IV) and for 3 major hematologic malignancies assessed by age group.

Until randomized comparisons studies are possible and the SEER data becomes more comprehensive, the specific causes of the observed benefit and identifying patients that benefit most may be subject to considerable debate. Additional research can help determine with greater granularity the drivers of the survival benefit and highlight an opportunity to make adjusted survival outcomes more accessible to patients, complementing the data currently available because of price transparency mandates. Such efforts may help ensure that all patients benefit from precision medicine approaches.