Evaluating Cancer Care Using the NCDB

The National Cancer Database (NCDB) was created in 1989 by the American College of Surgeons Commission on Cancer (CoC) and the American Cancer Society as a national cancer registry designed to drive quality improvement in cancer care in the United States. The CoC is celebrating its 100-year anniversary and it is appropriate to recognize the significant role that the NCDB has played in evaluating the practice of cancer care.

The breadth of information available in the NCDB lends itself to a myriad of projects that can help us promote better oncology care for everyone regardless of age, race, or stage of the disease. It captures information related to both common and uncommon malignancies, providing a snapshot of cancer care across the United States. A limited search of PubMed identified a sample of peer-reviewed articles that used the NCDB to describe the effectiveness of treatment regimens based on age, uncover disparities in care, and analyze practice patterns. The biggest strength of the NCDB is in its ability to be widely explored to improve the quality of cancer care.

For example, the NCDB has been used to evaluate how the treatment of breast care has changed in elderly patients:

Changing practice patterns of adjuvant radiation among elderly women with early stage breast cancer in the United States from 2004 to 2014
Reyes SA, Williams AD, Arlow RL, De La Cruz LM, Anderson DN, Ugras S, Brooks AD, Sataloff D, Freedman G, Tchou J. Breast J. 2020 Mar;26(3):353-367. doi: 10.1111/tbj.13491. Epub 2019 Sep 20. PMID: 31538703

Lumpectomy Plus Hormone or Radiation Therapy Alone for Women Aged 70 Years or Older With Hormone Receptor-Positive Early Stage Breast Cancer in the Modern Era: An Analysis of the National Cancer Database
Buszek SM, Lin HY, Bedrosian I, Tamirisa N, Babiera GV, Shen Y, Shaitelman SF. Int J Radiat Oncol Biol Phys. 2019 Nov 15;105(4):795-802. doi: 10.1016/j.ijrobp.2019.07.052. Epub 2019 Aug 1.PMID: 31377160

Breast cancer in women: a descriptive analysis of the national cancer database
Sisti A, Huayllani MT, Boczar D, Restrepo DJ, Spaulding AC, Emmanuel G, Bagaria SP, McLaughlin SA, Parker AS, Forte AJ. Acta Biomed. 2020 May 11;91(2):332-341. doi: 10.23750/abm.v91i2.8399. PMID: 32420970

Another strength of the NCDB is how it fosters an understanding of rare malignancy management:

Recent Trends in Vestibular Schwannoma Management: An 11-Year Analysis of the National Cancer Database
Torres Maldonado S, Naples JG, Fathy R, Eliades SJ, Lee JYK, Brant JA, Ruckenstein MJ. Otolaryngol Head Neck Surg. 2019 Jul;161(1):137-143. doi: 10.1177/0194599819835495. Epub 2019 Mar 12. PMID: 30857474

By using the NCDB, these investigators have contributed to the understanding of how we treat patients with advanced disease and identified areas for improvement:

Radiosurgery for Brain Metastases: Changing Practice Patterns and Disparities in the United States
Kann BH, Park HS, Johnson SB, Chiang VL, Yu JB. J Natl Compr Canc Netw. 2017 Dec;15(12):1494-1502. doi: 10.6004/jnccn.2017.7003. PMID: 29223987

Variation in hospital treatment patterns for metastatic colorectal cancer
Krell RW, Regenbogen SE, Wong SL. Cancer. 2015 Jun 1;121(11):1755-61. doi: 10.1002/cncr.29253. Epub 2015 Jan 29. PMID: 25640016

Lastly, the NCDB has been used to promote understanding of health care disparities and inequities in care based on race:

Racial Differences in Incident Genitourinary Cancer Cases Captured in the National Cancer Database
Wolff DT, Monaghan TF, Gordon DJ, Michelson KP, Jones T, Khargi R, Smith MT, Maffucci F, Kwun H, Suss NR, Winer AG. Medicina (Kaunas). 2021 Jun 29;57(7):671. doi: 10.3390/medicina57070671. PMID: 34209546

These NCDB-based studies demonstrate the value of having a coordinated data-driven effort that codifies cancer treatment, regularly reviews its effectiveness, and opens the door for further evaluation by all members of the cancer care stakeholder community. The creation of the NCDB and its purpose aligns well with the explosion of health services research helping us to understand where our resources are best utilized to maximize the health of populations and to achieve health equity.

The CoC is proud to support the NCDB and its impact on the care of cancer patients in the United States.

Paula M. Termuhlen, MD, FACS

Professor and Dean

Western Michigan University Homer Stryker, MD School of Medicine

NCDB-Generated Literature on Cancer Disparities

As we mark the centennial celebration of the Commission on Cancer and one of its poster products, the National Cancer Database, the 10 most highly cited literature on disparities published using NCDB data are worthy of highlight.

Utilization of the National Cancer Database (NCDB) to Access Postmastectomy Breast Reconstruction

The treatment of breast cancer is a multidisciplinary effort. Breast surgical oncologists, medical oncologists, and radiation oncologists work to create a comprehensive cancer treatment plan specific for each patient.

The NCDB and Childhood Cancer

The National Cancer Database (NCDB) receives information from across the country and centers contribute their cancer patient information. While the majority of the NCDB comprises adults with cancer, the database also includes children that develop cancer.

NCDB-Generated Literature and the Staging of Cancer

The staging world and especially the TNM system of the American Joint Committee on Cancer, has utilized the robust data source of the National Cancer Database to create, improve, and refine clinical and pathological staging of cancer and to add prognostic and molecular prognostic factors to the anatomical taxonomy of the TNM system.

Birthday Reflections: NCDB as a Tool for Fighting Structural Racism

The National Cancer Database (NCDB) is a hospital-based cancer registry, collecting standardized data on diagnostic, staging, treatment (including time to treatment), and outcomes for more than 70 percent of newly diagnosed cancer patients in the United States, and includes patients residing in all states.