NEW BRITAIN, Conn. – Had she faced breast cancer years ago, Gail Brown might have ended up traveling hours to one of the renowned cancer research hospitals in New York or Boston.
But when the 68-year-old retiree received her diagnosis this spring, a $40 million, 70,000-square-foot cancer center was opening its doors on a wooded hilltop here. Known as the Hartford HealthCare Cancer Institute, its leaders had formed a partnership with New York’s Memorial Sloan Kettering Cancer Center, part of an alliance aimed at bringing the most up-to-date cancer care to smaller communities.
The stone-and-glass center perched above Interstate 84 is part of a cancer building boom unfolding across the country, a wave of expansion driven by powerful economic and demographic forces.
For Brown, the new center was a short drive from her home and the obvious place to receive her treatments.
“I would drive anywhere, but I’m very comfortable here,” she said.
More than 1.6 million people in the United States will be diagnosed with cancer this year, according to the American Cancer Society, which says the number is certain to rise with the aging of the baby boom generation. Medical advances are allowing more people to live longer with cancer and, in some cases, to treat it as a chronic disease. There is a push to bring the latest specialized treatments and access to more clinical trials to patients who don’t live near major academic research centers. And there is fierce competition among hospitals searching for reliable revenue in a rapidly changing health-care landscape.
The Advisory Board Company, a global research firm that does health-care consulting, last year surveyed its members that have oncology departments about their plans for growth. More than 25 percent were building a cancer center or reported having built a facility during the previous three years.
What exactly does this rapid expansion of the nation’s cancer-fighting infrastructure mean for patients?
Ideally, it will allow more people to undergo often daunting and demanding cancer treatments closer to home. And it could mean a higher standard of care for a broader range of patients across the country.
But simply having more options does not guarantee better care across the board, some skeptics say.
Peter Bach, an oncologist and director of the Center for Health Policy and Outcomes at Sloan Kettering, said it’s easy for any facility to call itself a “cancer center.” But that doesn’t guarantee that each place will have doctors with deep expertise, a track record of good outcomes or credentials such as a National Cancer Institute designation as a top-notch center.
“That’s my concern, that consumers have no way of sifting through” those differences, Bach said. “If they are looking for care for their cancer, the moniker ‘cancer center’ conveys falsely the idea of expertise or quality. Does proliferation mean the average patient is more or less likely to get high-quality care when the market is flooded with places claiming to be cancer centers?”
The history of health care shows that more competition doesn’t necessarily lead to lower costs, and cancer is no different. It remains unclear whether the proliferation of cancer centers will hold down costs because patients have more facilities to choose from, or whether it will lead to more tests, surgeries and medications being billed to Medicare, private insurers and patients.
“It’s likely that (the expansion is) going to be a mixed bag,” said Paul Ginsburg, a Harvard-trained economist and a professor of health policy at the University of Southern California. “It’s going to help be able to meet growth and demand and serve more patients in a convenient way. But it’s likely to overshoot. In other words, we may build beyond the capacity we need, and that could add to costs.”
The country’s cancer boom is taking many forms.
Regional hospital systems from West Virginia to Indiana to Arizona are building state-of-the-art outpatient centers and research facilities – such as Inova Health System’s plans for a cancer institute in Fairfax County in Northern Virginia. Well-known cancer centers such as the Cleveland Clinic have undertaken massive building projects to consolidate cancer care and prepare for the expected influx of new cases in coming years.
Other well-known institutions such as Sloan Kettering in New York, MD Anderson Cancer Center in Texas and Johns Hopkins in Baltimore are forming alliances with smaller hospitals in an effort to extend their brands, in some cases around the country and the globe.
As with health-care growth in general, the expansion of cancer facilities is driven largely by math. An estimated 10,000 Americans are signing up for Medicare each day, and a startling number of them will end up with a cancer diagnosis.
“What drives the health-care market is epidemiology,” said David Knowlton, a former deputy commissioner of health in New Jersey who is the president of New Jersey Health Care Quality Institute, an independent watchdog group.
Knowlton said that 15 to 20 years ago, there was a surge in new cardiovascular units at hospitals as many baby boomers began suffering from heart problems. That same generation is driving the country’s burgeoning cancer rates, he said, and hospitals are building in areas that are either underserved or likely to produce a wave of patients.
Cancer also is a lucrative business at a time when many hospitals are operating on razor-thin margins.
“The economics of it are good,” said Patrick Duke, managing director at CBRE Healthcare, a consulting group that advises hospitals on real estate projects. “That’s a touchy subject for some people, but it’s the reality. There are a lot of patients out there; it affects everybody. The procedures and the drugs are well reimbursed. It’s a big business.”
Health officials involved in the wave of cancer-related construction and ever-expanding partnerships say that sensible business decisions are aligning with a genuine medical need.
“Cancer is going to overtake cardiovascular disease, if it hasn’t already, as the No. 1 cause of death for U.S. citizens,” said Brian Bolwell, head of the cancer institute at the Cleveland Clinic, which is building a $300 million outpatient center that is scheduled to open in 2017. “We’re seeing more and more patients. ... It shows no signs of abating. We literally don’t have enough space.”
Few organizations have the reach of Houston’s MD Anderson Cancer Center, which has partnered with hospitals and researchers from New Jersey to Arizona, as well as in places such as Istanbul, Spain and Brazil.
Amy Hay, MD Anderson’s vice president of business development, said the network is an extension of the organization’s effort to combat cancer everywhere, not just in Texas.
“In order to have a truly global impact on the way cancer is treated and the way we conduct research, we have to be having an impact on a global level,” she said. “Part of our job is eliminating the disparities in cancer care, not only on a national level but on an international level.”
In New Britain, Donna Handley, vice president of operations for the new cancer institute, said the area served by the local hospital system sees about 6,000 new cancer diagnoses a year. Many of those patients traditionally went elsewhere for treatment.
“We can tell you exactly who is leaving and for what types of cancers,” Handley said, adding that part of the impetus behind the new center is to ensure that “patients don’t have to travel for highest-quality cancer care.”
That appeals to Gail Brown, who recently finished numerous rounds of chemotherapy at the hilltop cancer center and will follow that with a course of radiation.
“It is a tiring experience,” she said of dealing with cancer. “To have this right here is wonderful.”
