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There are two types of NCI-designated cancer centers:
» An NCI-designated cancer center must demonstrate scientific leadership, resources and capabilities in laboratory, clinical or population science, or some combination of these three components. It also must demonstrate reasonable depth and breadth of research in the scientific areas it chooses and research across these areas. UNMC's Eppley Cancer Center is such a center.
» An NCI-designated comprehensive cancer center must demonstrate reasonable depth and breadth of research in each of three major areas: laboratory, clinical, and population-based research, as well as substantial research that bridges these scientific areas. In addition, a comprehensive center also must demonstrate professional and public education and outreach capabilities, including the dissemination of clinical and public health advances in the communities it serves.
Of the 66 NCI-designated cancer centers, 40 are comprehensive cancer centers.
INTERACTIVE MAP: UNMC Cancer Center Project
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Treating the toughest cancer cases. Competing with the Mayo Clinics of the world.
The goal behind the $370 million cancer center proposed for the University of Nebraska Medical Center campus is not to lure patients from other local providers. It's to "provide an option so people don't have to leave the state for the most significant care," said Glenn Fosdick, CEO of the Nebraska Medical Center, UNMC's hospital partner.
But just how many patients the project would draw isn't yet known; officials are just beginning that analysis. How it would affect existing cancer centers isn't clear, either.
The Nebraska Medical Center already pulls in certain patients, such as those seeking transplants or people with lymphoma, from across the nation and overseas. "You want to continue that," Fosdick said. "Part of the goal is to protect what we have now and attract more business."
The med center currently pulls 20 percent of its patients — and revenues — from other states and countries (15 percent from Iowa, 3 percent from Missouri, South Dakota or Kansas and the remaining 2 percent from farther away).
One UNMC official estimates that designation as a cancer center, which officials hope to achieve with the project, would boost the number of out-of-state patients drawn to Nebraska by at least 5 percent. Dr. Kenneth Cowan, director of UNMC's Eppley Cancer Center, added that if the designation is not achieved, "we likely would see this percentage decrease because of competition with other leading cancer centers nationally."
It's possible, though, that such a project could take business from other local hospitals that offer cancer treatment.
"The other providers probably are not doing handsprings over this," said Alwin Cassil of the Center for Studying Health System Change in Washington, D.C. "It is likely to cut into their patient bases. If you have a chance to go to a brand new, shiny comprehensive cancer center, then, why not?"
Fosdick said he's not sure of the impact the project might have on patient numbers at area hospitals. Paul Baltes, a spokesman for the Nebraska Medical Center, said all area hospitals play a role in treating local cancer patients, and officials don't think the new project will harm other hospitals.
The project would add 28 oncology beds to the 80 the Nebraska Medical Center has now.
It wouldn't be possible, Baltes said, for one hospital to treat everyone: "We all sort of depend on each other."
Alegent Health officials declined to comment on the med center project. Creighton University Medical Center spokeswoman Kelsey Archer noted its hospital's recent oncology upgrades and said it offers "all aspects of cancer treatment — from early detection and diagnostic screenings to treatment and therapy."
John Fraser, president and CEO of Methodist Health System, said Methodist Hospital and Methodist's Estabrook Cancer Center have a longstanding and cooperative relationship with UNMC and the Nebraska Medical Center.
"UNMC's expansion project represents an opportunity to grow the relationship between our institutions while expanding diagnostic and treatment opportunities for our patients," Fraser said in a written statement. "Most of all, the project will be a tremendous benefit to residents of the Omaha metropolitan area, the state and the multi-state region."
Cassil said the larger issue is not so much how the project would affect other providers but, "Does the community need this and can it support it or not?"
Nebraska no longer has a "certificate-of-need" process for hospitals. That process required state review of new hospital services and projects that cost more than threshold amounts. But the value of the reviews often was questioned, and the Nebraska Legislature phased out the reviews in 1997.
The med center project could give hospitals in Nebraska an opportunity to evaluate their own programs, said Jessica Kennedy, communications director of the Nebraska Hospital Association. "This provides the chance for a hospital or a cancer center to look at what they provide — what they can increase, what they can pull back on."
Nebraska Medical Center officials know that patients now go out of state for treatment of some cancers, partly because some come to the med center for second opinions or consultations after visits elsewhere. Fosdick said analysts have been hired to better determine how many patients leave the state to get cancer treatment at such places as the Mayo Clinic Cancer Center in Rochester, Minn., or M.D. Anderson Cancer Center in Houston.
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He said that analysis would have been done before the proposal was announced, but the deadline for introducing bills in the Nebraska Legislature forced officials' hand. (Officials are seeking $50 million in state money to help finance the project.)
Mayo, M.D. Anderson and Memorial Sloan-Kettering Cancer Center in New York City are among 40 National Cancer Institute-designated "comprehensive cancer centers." Eppley Cancer Center on the UNMC campus already is an NCI-designated cancer center — the only one in the state — but officials are seeking the added "comprehensive" designation.
"The difference is connecting the research with the care that's being provided," Fosdick said.
Patients in the Midlands can participate in clinical trials of emerging cancer treatments through many area facilities. Part of the attraction of NCI-designated cancer centers is the increased availability of such clinical trials. A comprehensive designation would expand that further and better integrate the research with the treatment.
Kelly Madcharo, director of the Nebraska Cancer Research Center in Lincoln, said her center and other providers are part of the Missouri Valley Cancer Consortium, which gets federal funding designed to bring cancer clinical trials to Omaha, Lincoln and the surrounding area. The consortium is part of the Clinical Community Oncology Program network, which was developed by the National Cancer Institute to facilitate cancer prevention research efforts.
"We have a very good menu of studies available," Madcharo said.
"I'm not saying what they're planning isn't a good idea," she said of med center officials. "I don't necessarily think that people need to go to UNMC to get cutting-edge treatment."
The Eppley Cancer Center's Cowan said with the new project, area hospitals and patients would be able to plug into more early-phase clinical trials of cancer treatments evaluated by med center researchers. "We want to work with the hospitals across the city and the state to develop clinical trials," he said.
The National Cancer Institute says an NCI-designated cancer center has a scientific agenda that is primarily focused on laboratory, population-based or clinical research, or some combination of the three. A comprehensive cancer center must demonstrate reasonable depth and breadth of research in all of those three areas, with substantial research that bridges the three.
Getting researchers and physicians under one roof will make it easier for them to collaborate and apply what's learned in the lab to patients' cases, Cowan said.
"If we are going to design new therapies that take advantage of the new, targeted therapies being developed," he said, "we have to have the scientists and physicians working together."
Such interactions already take place at UNMC and the Nebraska Medical Center, Cowan said, "but it's less frequent than we would like."
Comprehensive cancer centers also attract complex cancer cases. Hospitals across Alabama, for example, send tough cases to the University of Alabama at Birmingham Comprehensive Cancer Center, said Dr. Martin Heslin, its associate director for clinical programs.
UAB's center also developed a "cancer care network" to provide community health-care providers access to cancer research and enable patients to receive care close to home. The network links the UAB Cancer Center with community cancer centers and hospitals in Alabama, Georgia and Florida.
Heslin has heard concerns about competition from oncologists at both the affiliated hospitals and the UAB cancer center. The outside oncologists, he said, say, "Don't steal my patients." The cancer center oncologists ask, "How can you create networks with these affiliated hospitals and have no patients come here?"
Heslin's response to both: Focus on the patients and what's best for them. No one, he said, can argue with that.
Contact the writer:
402-444-1109, bob.glissmann@owh.com
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