As local cancer centers grow, hospitals look for ways to advertise their superiority

Competition is building in the cancer-care field, as hospitals, health systems and physician groups are constructing new cancer centers in response to the aging of the baby boomers and a projected increase in cancer diagnoses over the next 20 years.

An Advisory Board Co. survey last year found that 28% of health systems it surveyed had built a new cancer center in the previous three years. One study estimated there will be a 45% increase in cancer diagnoses by 2030. The National Cancer Institute projects that spending on cancer care may reach $207 billion by 2020, up from $125 billion in 2010.

As money is invested in new centers and providers compete for the influx of patients, they face the challenge of effectively marketing their cancer services to distinguish them from their competitors in terms of quality. That's particularly difficult for community hospitals that want to attract patients away from big-name cancer centers with National Cancer Institute designations. Meanwhile, some experts are raising questions about the accuracy and ethics of cancer-care marketing campaigns, and those concerns are likely to become more widespread with the cancer-care boom.

Americans facing a cancer diagnosis traditionally have sought out the prestigious centers in big cities. But as the number of patients grows—and as the approach to cancer care becomes more personalized with more social support—there's more demand for care at the local level, cancer experts say.

Hospitals and physician groups throughout the country are responding to that demand, given that cancer treatment can be lucrative. Some hospitals have built new cancer facilities after they purchased or affiliated with oncology practices, said Jessica Turgon, cancer services practice leader for ECG Management Consultants. “Systems are trying to provide one-stop shopping” to make cancer treatment easier on patients, she said.

The building spree raises questions about how consumers can know whether they will receive the same quality of care for their condition at a community hospital as they would get from a major cancer center. There are just 45 NCI-designated centers, while there are about 1,500 cancer programs accredited by the Commission on Cancer, which is run by the American College of Surgeons.

Determining quality of care is not easy for cancer patients, said Ann Geiger, acting associate director of the NCI's Healthcare Delivery Research Program. “There's not a lot of good information out there with which patients can make decisions,” she said.

Dr. Randall Holcombe, chief medical officer for cancer care at Mount Sinai Health System in New York, said it's critical for a program not just to provide all the pieces of cancer care but to coordinate them. “Some places call themselves a cancer center but don't really provide coordinated care,” he said. “It can be a marketing ploy to encourage patients to come.”

To demonstrate their quality, some community hospitals are affiliating with a big-name center. MD Anderson Cancer Center, for example, plans to add up to six partner institutions that aspire to provide an MD Anderson-level of care. The Houston-based center's plan also involves offering a network of community hospitals with “certified membership.” So far, 13 hospitals have joined that program. One of them, Community Health Network in Indianapolis, reports that in three years, its affiliation with MD Anderson has increased its volume of cancer patients by 250%.

“MD Anderson's mission is to eradicate cancer,” said Amy Hay, vice president of global business development for MD Anderson. “To do that, we have to have an impact, not only here in Houston, but across the U.S. and the globe.”

Similarly, ProHealth Care in Milwaukee is contracting with the University of Wisconsin Carbone Cancer Center in Madison, which is NCI-designated. ProHealth opened a $70 million cancer center in August.

For community hospitals that are building new cancer centers without the imprimatur of a prestigious cancer-care brand, their marketing usually focuses on the benefits of getting quality cancer care close to home. That's increasingly important to patients undergoing lengthy courses of treatment with difficult side effects.

“When it comes to the more common types of cancer, community hospitals are often well-equipped to provide excellent care,” said Lindsay Conway, managing director of research and insights for the Advisory Board.

Baptist Health Paducah (Ky.) broke ground in September for an $8.3 million regional cancer-care center with private chemotherapy rooms, family space, lab and physician offices, with a radiation therapy center next door. Its purpose is to pull Baptist's far-flung treatment centers into one location and offer a local alternative for patients who might otherwise travel 135 miles to Vanderbilt University Medical Center in Nashville, said Baptist Health Paducah President William Brown. He doesn't see the expansion as a challenge to Vanderbilt, where Paducah patients may still go for second opinions or highly specialized care.

In Maine, a rural state where most residents lack nearby access to an academic medical center, New England Cancer Specialists has adopted an oncology medical home model for its 13 oncologists, with each specialist leading a multidisciplinary team that provides comprehensive care.

Steve D'Amato, the oncology practice's executive director, said that with the expansion of alternative payment models, the only way large oncology practices will be able to survive in the future will be by providing comprehensive care. That includes access to clinical trials, genetic testing, oncological rehabilitation, functional medicine, long-term support for cancer survivors and palliative care, he said.

There is no generally accepted definition of the term cancer center. Facilities that call themselves cancer centers may offer any or all of an array of services, including diagnostic imaging, surgery, radiation therapy, chemotherapy, immunotherapy, access to clinical trials, support services such as physical therapy, rehabilitation, support for cancer survivors, nutrition and palliative care.

In its accreditation program, the Commission on Cancer separates cancer programs into several categories including integrated networks, academic programs, community-based programs and free-standing centers. NCI designates 69 comprehensive cancer centers that have a research orientation. The Association of Community Cancer Centers has about 20,000 members that work on multidisciplinary cancer teams in various settings. Then there is the Alliance of Dedicated Cancer Centers, comprising 11 centers that have been exempt from Medicare DRGs since 1983 because of their focus on one disease.

Hospitals are most likely to tout the aspects of their cancer program that differentiate it from the competition, said healthcare marketer Chris Bevolo, executive vice president of consumer engagement at ReviveHealth. That differentiator may be an affiliation with a prestigious academic medical center, the availability of high-profile cancer specialists or a new building. “It's all about positioning. It depends on what you're up against in your market,” he said.

Marketing is directed both to referring physicians and to cancer patients. Those with serious or rare diagnoses often are prepared to travel far to get a second opinion or see a subspecialist, Bevolo said. “People are willing to go much further for surgical procedures or life-threatening situations” to centers such as MD Anderson, Johns Hopkins Hospital in Baltimore or Memorial Sloan Kettering Cancer Center in New York. “That's a challenge for the community hospital,” he said.

Much cancer-center marketing and advertising is simple, emotional content, according to research published in the Annals of Internal Medicine in 2014. Its analysis of magazine and TV ads by 102 cancer centers in 2012 found that 85% used emotional appeals, 61% evoked hope for survival and 41% depicted cancer treatment as a fight or battle. Treatments were promoted in 88% of the ads and 27% described their benefits. But only 2% talked about treatment risks, and just 5% mentioned cost or insurance coverage issues.

While marketers argue that hospital ads offer patients useful information, researchers studying these ads were “underwhelmed” by the information provided, said analysis co-author Dr. Yael Schenker, an assistant professor of medicine at the University of Pittsburgh. “Emotional appeals are more persuasive than hard facts and tables,” she said, but they don't authenticate a center's quality of care.

In a paper published earlier this year in the Journal of Cancer Policy, Mount Sinai's Holcombe expressed concern about the ethics of marketing cancer care and suggested the need for Joint Commission regulation.

“There's a significant amount of competition among centers … and cancer patients are particularly vulnerable” to marketing because they may be frightened by their diagnosis and feel a sense of urgency in getting treatment, Holcombe said in an interview. “Cancer patients may see an (ad that says), 'I went here and near-miracles happened for me.' People will expect that's what's going to happen, even if there's small writing on the screen that says this is not typical. Those kinds of ads border on the misleading and should be avoided if possible,” he said.

But it's not easy for hospitals to develop cancer-care ads with more substantive information that consumers can understand and use. “A lot of people like to think if we turn consumers loose with information, that will solve all our problems,” Bevolo said. But it's “really complex stuff” to find the cancer center that's best for a particular patient.

For example, survival data are the most common metrics used to evaluate cancer care. But because of the statistical complexities of publishing survival rates, the Commission on Cancer asks its accredited programs not to use the data it collects in their public marketing materials. In February, the commission told cancer programs, “Publishing unadjusted survival rates or risk-adjusted survival rates, with or without confidence intervals and statistical interpretation, can lead to erroneous conclusions.”

Many cancer centers use accreditation or certification to showcase their quality. But advertising accreditation or certification may be confusing to consumers, said the Advisory Board's Conway. An Advisory Board survey of about 400 former cancer patients found that accreditation was not important to them in evaluating potential providers. Their top concerns were a doctor who specialized in the patient's type of cancer, the center's technology and treatment options, and its clinical quality.

There are other, easier-to-understand ways to describe quality of care, such as guaranteeing a consultation within a day or two after a patient contacts a center, Conway said. It's also helpful, she said, for patients to know their care team.

Nebraska Medicine in Omaha, for example, puts up YouTube videos of its physicians discussing treatment options as a way to get a sense of physicians' manner and personalities. In one of these, cancer surgeon Dr. Jason Foster tells viewers about his upbringing and education, along with his thoughts about his work.

Ultimately, patients will go where their doctors and insurers direct them, the NCI's Geiger said. If they have some choice, advertising may matter.

Jan Greene is a freelance writer based in Alameda, Calif.