Teena Patterson was diagnosed with inoperable cancer in January, 2004. Thinking she had gallstones, the hairdresser from Council Grove, Kan., went to see her family physician for a sonogram. The doctor discovered her liver was spotted with tumors. For six months, Patterson and her husband, Steve, a truck driver for Frito-Lay (PEP), traveled 60 miles each way to Topeka every three weeks for chemotherapy. The drugs shrank the growths, but Patterson lost faith in her oncologist when he told her she asked too many questions.
Then her sister-in-law passed along a videotape she had ordered after seeing a commercial for Cancer Treatment Centers of America (CTCA). Patterson was immediately drawn to its message of holistic healing and personalized care. After confirming that her insurer, Blue Cross & Blue Shield Assn., would cover treatment at the for-profit chain, she was soon on a plane to CTCA's Midwestern hospital outside Chicago for continued chemotherapy and radiation. Patterson, 50, returns to the facility once a month for an infusion of chemotherapy drug Erbitux and a checkup. She still has end-stage cancer. But the tumors appear to be in remission, and she feels good. She credits the CTCA staff. "Their way with people is wonderful," she says. "They really want you to succeed."
For years the provider choice for cancer patients has been either a community hospital or a big-name teaching institute. Now there's a third way: for-profit cancer hospitals. Many are local or limited-treatment outfits, such as physician-owned Arizona Oncology Services, which has 11 Phoenix-area clinics that offer only radiation therapy. But Aptium Oncology, a Los Angeles subsidiary of drugmaker AstraZeneca (AZN), just opened its ninth outpatient center, in Elizabeth, N.J., giving it properties in four states. U.S. Oncology of Houston, which has 97 facilities in 33 states, boasts that it treats more cancer patients than any other organization in the country.
For many people, particularly those with rare forms of the disease, the medical-school centers remain the preferred option. The National Cancer Institute accredits 39 comprehensive cancer centers in the U.S. Among them: Northwestern Memorial Hospital's Robert H. Lurie Comprehensive Cancer Center in Chicago and the Mayo Clinic in Rochester, Minn. These giant institutions may not be as convenient as the neighborhood hospital -- half the states, in fact, don't have an NCI-designated comprehensive center -- but they have the budgets for multimillion-dollar radiological machines and other high-tech equipment, not to mention acclaimed medical practitioners and unrivaled access to experimental drugs and procedures.
Most important, they may come out ahead on effectiveness. Although there are no national data ranking cancer facilities by survival or recurrence rates, studies have shown that patients do better when their surgeons have performed the same operations over and over again. For example, Dr. William J. Catalona, director of Northwestern's clinical prostate-cancer program, has performed 4,700 nerve-sparing prostate removals, and is still doing 25 to 30 a month. "You look at our centers and the magnitude of the faculty and the research, and there's got to be some very fundamental differences" over the for-profit chains, says Patricia J. Goldsmith, senior vice-president of business development at the National Comprehensive Cancer Network, which represents 19 centers.
Still, a just-published study by health and science consultancy RTI International in Research Triangle Park, N.C., finds that for-profit facilities may be an acceptable alternative. The government-funded report, in the January/February issue of Health Affairs, notes that, by their nature, specialist centers often have the expertise and high volumes that all-purpose community hospitals lack. Plus, since they're usually smaller, they can be more personal in patient treatment. "Quality of care is not just dependent on the guy who cuts," says Leslie Greenwald, a senior scientist at RTI and the study's lead author. "It's the nurse who takes care of you and the lab personnel; it's the whole package."
Of all the for-profit cancer centers, U.S. Oncology is the biggest and fastest-growing. The company, taken private in a $1.6 billion buyout in 2004, opened five centers last year in partnership with local doctor groups and other investors, increasing its annual revenue to $2.5 billion. Its site in Maplewood, Minn., is typical. One of seven in the Minneapolis-St. Paul area in the Minnesota Oncology Hematology Professional Assn., the facility each week treats roughly 200 outpatients already diagnosed with cancer. Lab work is done on the premises, with results promised in 30 minutes.
The clinic does no surgery, but it offers chemotherapy, including drugs in experimental trials, and radiation treatment. The infusion area is utilitarian: a row of 18 vinyl recliner chairs in a linoleum-tiled room with six TVs suspended from the ceiling and plastic trash cans on the floor. Its radiological equipment, though, includes a state-of-the-art linear accelerator that can zap a tumor from almost any angle with sub-millimeter precision. The machine, from Varian Medical Systems (VAR), lists for $5 million. The Minnesota network has two other selling points: Most insurance plans, including Medicare, cover its services, and it is convenient.
While it's also profit-driven, CTCA is more like a mini-version of Boston's Dana-Farber Cancer Institute than an outpatient-only chain. Its facilities provide chemotherapy, radiation treatment, and stem-cell transplants, but they also have state-licensed hospital rooms. Patients, who travel an average 540 miles one way, can check in and be treated over days if necessary. The centers also have operating rooms and their own oncology surgeons. The company, in Schaumburg, Ill., which began in 1988 with a former community hospital in Zion, Ill., has hospitals in Tulsa and Philadelphia. CTCA has applied for a hospital license in Seattle, where it has an outpatient facility, and plans to expand to Atlanta.
The privately held company eschews physician referrals and advertises to people with late-stage cancer, promising to do almost anything they want to combat the disease. In its Midwestern Regional Medical Center in Zion, the professional staff -- radiologists, nutritionists, physical therapists, nurses, pharmacists, a pastor, and even a laughter therapist -- meet three times a week to review each patient's condition. In smaller teams, they go from room to room daily to check on patients.
Charges can add up quickly, just as they would at a comprehensive cancer center. Patterson says that after 18 months of treatment at CTCA, including an eight-week stay last summer for radiation and $28,000 a month for her current course of chemotherapy, she is about to max out on her $1 million lifetime coverage through her husband's health-care plan. She is now shopping for a new policy, with higher premiums and deductibles. Still, Patterson has no thoughts about going somewhere else. For her, and for plenty of other cancer patients, the third way is the right way.
By Michael Arndt