By Matthew Cunningham, Partner
“How many academic cancer centers are there in the United States?” is a question that will receive answers ranging from 30 to well over 100, depending on who you ask. The confusion surrounding the definition of an academic cancer center can be attributed to many factors, but the reality is that the lack of clarity can have real-world implications on both patients and manufacturers.
Patients seeking to make informed treatment decisions can easily become overwhelmed by the dozens of organizations promoting their academic status, clinical trials, and leading specialists. Manufacturers make important decisions regarding clinical trials, distribution networks, contracting, field force planning, and resource allocation based on the “academic” concept, but without a consistent definition, these strategic decisions may be uninformed and potentially leave gaps in both medical and commercial strategies.
What Defines an Academic Cancer Center?
While there is no consensus on what defines an “academic cancer center,” there are certainly plenty of options, which unfortunately can only add to confusion for both patients and manufacturers.
Some potential frameworks lean on teaching expertise:
- CMS Teaching Hospitals (N=1,457): “Academic” implies teaching and education, and CMS has designated 1,457 “teaching hospitals” that house residency programs. However, this is not oncology-specific, so we are certainly starting with a broad list to refine.
- Oncology Fellowship Presence (N=162): Defining an “academic cancer center” as an organization teaching oncology fellows is a logical approach. Currently, there are 162 programs in the country offering hematology/oncology fellowship programs. While this framework makes sense, the spectrum of institutions is wide, ranging from MD Anderson to for-profit HCA Florida Westside Hospital. The spectrum of institutions with fellowship programs and the sheer size of the list can pose problems for stakeholders looking for a targeted list of academic medical centers. Additionally, this would raise valid questions on whether this framework should also include related fellowship programs such as radiation oncology, surgical oncology or pathology.
Other potential definitions rely on well-established accrediting organizations:
- NCCN (N=33): The National Comprehensive Network (NCCN) is seen by many as the “best of the best” for cancer centers. However, this group of 33 institutions is recognized mostly for developing national guidelines and rarely admits new members. If NCCN is the sole universe of our “academic definition,” then there will also surely be disagreement from individuals who believe sophisticated, non-NCCN institutions such as Emory, Mount Sinai or Georgetown are being wrongly left out.
- NCI (N= 65): The National Cancer Institute (NCI) has designated 57 comprehensive cancer centers and eight cancer centers, which meet rigorous standards surrounding program infrastructure and research. While NCI-accredited programs have passed a rigorous accreditation process, it may also be difficult to tell officials at institutions such as the University of Rochester or the University of Florida that they are not “academic.”
- AACI (N=107): The Association of American Cancer Institutes expands our list to over 100 and has membership criteria generally aligned to how most would define an “academic cancer center” such as an affiliation with a research institution and not-for-profit status. However, AACI is generally less recognized and marketed compared to aforementioned accreditation peers, and the membership criteria are significantly more relaxed.
What Patients Need to Know About Academic Cancer Center Definitions
As cancer centers spend hundreds of millions of dollars annually on advertising , patients with physical and emotional distress are faced with the critical decision of where to receive care. Disease-specific nuances and personal situations should drive decision-making as opposed to self-appointed marketing monikers. The accreditations listed above highlight the grey area surrounding an “academic center” definition, but as community practices and regional health become more sophisticated with complex therapies, Phase I trials, and dedicated specialists, the “grey area” becomes even more pronounced. Furthermore, more specific accreditations aligned to departments (e.g. NAPBC for breast cancer, MMRC for multiple myeloma, and ACR for radiation oncology), may be just as relevant for patients as organization-wide accreditations.
Recommendations for Manufacturer Site of Care Definitions
As manufacturers continue to make hugely consequential strategic decisions based on “academic” cancer classifications (and broader site of care definitions), the following principles may be considered:
- Consistency is Key: Regardless of what methodology is used to define “academic,” consistency in the application of the definition is critical in grounding strategies based on defendable frameworks to both internal and external stakeholders.
- Be Wary of Mixing “Academic” with Other Classification Metrics: No matter what framework is used, academic centers can have payer arms, be 340B-eligble, have satellite sites capturing GPO discounts, or be PPS-Exempt. Mixing these various metrics into a single site of care or segmentation framework can lead to non-mutually exclusive criteria, internal confusion and disjointed strategy.
- Accreditations as an Input Not an Output: As manufacturers look to identify the most clinically sophisticated centers for their market, academic accreditations can be used as a valuable input. That being said, many other inputs can also be valuable, such as trial experience, internal infrastructure, presence of specialists, speed to novel therapy adoption, and tumor board sophistication. These metrics (and others) in combination with “academic status” can ultimately be leveraged to develop a defendable list of clinically sophisticated centers best aligned to the organization’s priorities.
To learn more about how The Dedham Group’s expertise can help inform site of care and key account strategies, contact us.
