NCCN Cancer Case Manager™

Help is here for busy case managers.

NCCN Cancer Case Manager™ is an informational resource for case managers designed to facilitate appropriate decision-making about the management and referral of all types of cancer, including those that involve complex, aggressive, or uncommon cancers. Cancer Case Manager profiles NCCN Member Institutions with specific reference to areas of expertise, pediatric oncology specialties, and programs in genetic testing and counseling. Additional information includes a directory of expert physicians from NCCN Member Institutions, a glossary of terms derived from the NCCN Clinical Practice Guidelines in Oncology™, and the NCCN/ACS Treatment Guidelines for Patients. NCCN Cancer Case Manager also instructs on how case managers can schedule an appointment at an NCCN Member Institution and receive information about current clinical trials. Additional information includes:

• Profiles of NCCN’s 21 Member Institutions outlining specific areas of expertise
• Quick-reference contact pages for each NCCN Member Institution
• Directory of expert physicians at NCCN Member Institutions
• Glossary of terms derived from the NCCN Guidelines
• CD-ROM containing the Complete Library of NCCN Clinical Practice Guidelines in Oncology™
• CD-ROM containing available NCCN/American Cancer Society(ACS) Treatment Guidelines for Patients
  

Focus on Cancer Care Quality
NCCN Member Institutions are cancer centers of excellence that see and treat high numbers of cancer cases. This is important because in many areas of cancer care, there is a direct correlation between better patient outcomes (e.g., survival) and higher number of cases treated, as reported in a study from NCCN Member Institution Memorial Sloan-Kettering Cancer Center.¹

Focus on Cancer Care Effectiveness
Errors in cancer diagnosis can have serious implications for patient treatment (both immediate and longer term), patient prognosis, and health care expenditures. NCCN Member Institutions specialize in cancer care and have specialized expertise in both diagnosis and treatment. A significant number of errors were found among diagnoses performed at referring hospitals.² In a study of 500 consecutive brain/spinal cord lesions that were sent for a second opinion to another NCCN Member Institution, The University of Texas M. D. Anderson Cancer Center (UT-MDA):

• 43.2% had disagreement on diagnosis between the referring center and UT-MDA.
• 8.8% were classified as serious diagnostic errors with critical therapeutic implications. If treatment had been initiated based on the original diagnosis, it would have been inappropriate or inadequate, and would have had immediate or delayed implications for preserving life or maximizing the quality of life.
• 19.2% were classified as less serious but substantial, with immediate implications for quality of life and prognosis.
• UT-MDA performs 1,500 pathology reviews per year vs. 30 to 200 per year in the referring centers.

Focus on Efficiency
Consider the case of a patient who was misdiagnosed with glioblastoma at a cancer center that sees a low volume of brain tumors. This patient received a six week course of radiation therapy before being referred to a high-volume cancer center, where the correct diagnosis of neurocytoma was made. The corrected diagnosis meant that surgical excision of the tumor was the recommended treatment and that radiation therapy was unnecessary. The six-week course of radiation therapy wasted $26,406 and risked side effects for the patient.

Focus on Volume and Cost
The literature demonstrates how choosing high-volume cancer centers can have a positive impact on mortality, length of stay (LOS), and charges. One study examined data for an NCCN Member Institution – the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins – vs. 38 other hospitals in Maryland for patients undergoing the Whipple procedure for pancreatic cancer.³

These and other scientific studies demonstrate the importance of providing case managers with access to resources for the evaluation of more complex, aggressive, or rare cancer cases and for referral to high-volume academic cancer centers. Information in NCCN Cancer Case Manager™ supports case managers in providing information and decision support to patients and families about appropriate treatment options and the appropriate setting for the delivery of such care.

1. Begg CB, Cramer LD, Hoskins W, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280 (20):1747-51.
2. Bruner JM, Inouye L, Fuller GN, Langford LA. Diagnostic discrepancies and their clinical impact in a neuropathology referral practice. Cancer. 1997;79 (4):796-803.
3. Gordon TA, Burleyson GP, Tielsch JM, Cameron JL. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg. 1995;221 (1):43-9