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

Abstract 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