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Cancer Treatment Centers of America (CTCA) Effective?

[I wrote this originally as a response to a question asked by Quora by a Quora user. My response attracted the attention of an employee of CTCA, who engaged me in a debate that I felt was derailing, given that I have access only to what was PUBLICLY available. The employee then solicited the testimonial of a former patient to write a “non-answer” because she does not address “effectiveness” of this treatment center, only how wonderful she felt they were.]

1 Nov, 2012 My response is to the specific component of the question that talks about “effective”-ness, which in the oncology world tends to mean “survival rates.” I’m not talking bedside manners, or how nice everyone is, which are important for patient satisfaction of course, but is not a direct response to EFFECTIVE.

I was not discussing the treatment model, and since I have no conflict of interest (read: access to privileged data or have financial stake in the institution), I could only speak to what is available to me as a member of the general public.
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12 Nov, 2011
I’ve seen many commercials for the Cancer Treatment Centers of America (CTCA) here in California. The commercials have one thing in common: comparing how the patient may have been treated (bedside manners) by oncologists elsewhere, versus how patients may be expect to be treated by oncologists at CTCA. I’ve seen 2 different commercials and both highlight how the patients were treated with more compassion and also had a good outcome (these patients survived long enough and are healthy enough to make these commercials.)

I’m sure you’ve already done the internet searches and read about the controversies with CTCA around their FTC settlement:

http://en.wikipedia.org/wiki/Cancer_Treatment_Centers_of_America#Controversy
http://www.quackwatch.org/02ConsumerProtection/FTCActions/ctca.html

This was many years ago. Let’s assume for the benefit of this answer (since I’m not going to rehash what you can find searching for CTCA online), here’s the approach I took to answer this question, which asks about practices and treatments.

“What clinical trials are being offered or have been offered by CTCA, compared with other cancer centers?”

The rationale is that patients should expect standard-of-care cancer treatments by both CTCA and a comparator cancer center — but should also expect a substantive number of clinical trials offered by CTCA when compared with comparator cancer center — because this can be an indicator of “best practices” and “clinical options.”

I will compare CTCA with another for-profit treatment center, US Oncology (which has been acquired by McKesson Corporation in 2010).

As of 11/12/2011 a search on Clinicaltrials.gov showed the following:

CTCA — 23 Studies total
US Oncology — 5928 Studies total

Compared with US Oncology, CTCA has significantly less # of studies total in “experience.” But this may simply be a function of tenure. If you’ve been around forever, then of course you’re going to have more “experience”, so let’s look at history:

CTCA was founded in 1988.
US Oncology was founded in 1999.

CTCA has been around 11 years longer than US Oncology. I’d expect CTCA would have a higher level of research activity. Let’s now look into specific research activities — back to the clinicaltrials.gov numbers — if I only include studies that are currently ongoing / recruiting patients:

CTCA — 7 studies total (http://clinicaltrials.gov/ct2/results?term=%22cancer+treatment+centers+of+america%22&recr=Open )
US Oncology — 1956 studies total (http://clinicaltrials.gov/ct2/results?term=us+oncology&recr=Open )

Open studies means alternative treatment options for those patients who may not be able to tolerate “gold standard” treatment options or who may no longer respond / become refractory to the gold standard options. Here US Oncology wins with # of clinical trials available to patients.

Within the open clinical studies for CTCA, 2 of these trials aren’t treatments but rather nutritional/feeding interventions in patients with cancer. So technically, CTCA has 5 cancer studies open versus US Oncology’s 1000+. Also CTCA’s open studies are for solid tumors (breast, lung, liver, ovary) while US Oncology’s open studies span both solid and liquid tumors (leukemia, multiple myeloma). Of course, what actually matters is the patient’s cancer type as opposed to whether current options for studies are for solid versus liquid tumors.

Specific to CTCA, I looked into their page of treatment outcomes, since this serves as a major advertising point for patients: cancer patients want to go where they believe they may have an advantage when it comes to survival. I looked at their “statistics” on breast cancer and prostate cancer, but I looked at patient # that was used to come up with the statistic:

Prostate cancer: “61 advanced-stage prostate cancer patients who were diagnosed between 2004 and 2008 and who received treatment at CTCA for the duration of their illness.” http://www.cancercenter.com/prostate-cancer/survival-outcomes.cfm
Breast cancer: “97 advanced-stage breast cancer patients who were diagnosed between 2004 and 2008 and who received treatment at CTCA for the duration of their illness.” http://www.cancercenter.com/breast-cancer/survival-outcomes.cfm

Immediately I have problems with these statistics:

Are you telling me that in 4 years’ time, you have treated only 61 advanced stage prostate cancer patients and 97 advanced stage breast cancer patients? I bet US Oncology treats that many patients within a 6 month period. Even if you have fewer centers than US Oncology, I take pause in these low #’s of patients included for analysis… until:
I look at this critical statement: “who received treatment at CTCA for the duration of their illness” — this means those who received treatment BUT DID NOT RESPOND WELL are likely EXCLUDED from the analyzed data. Why? Because patients with advanced cancer who are not improving at CTCA will likely go elsewhere to receive alternative treatments or get on a clinical trial. This means the data that was analyzed to show impressive survival rates may be SELECTED and therefore, BIASED.

In other words, I can’t believe these survival claims. It doesn’t mean that CTCA can’t be telling the truth, it only means that for the above, it is a selective sample and not necessarily the whole truth. Show me the # of patients who stayed for the duration of their cancer treatment at CTCA with the # of patients who LEFT for another treatment cancer for the duration of their cancer treatment and then we’ll have a more meaningful discussion.

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Since I’d “deleted” the answer (it’s actually not truly deleted, but still resides on Quora if I choose to reactivate my account in the future) I wanted to include the comments from other (critically thinking) users. No doubt, my answer being featured in the Quora digest was what attracted CTCA’s “PR” damage control team. Hey, I used to work in pharma, I know all about tactics, and I also know from experience, this does not make the company / establishment more “credible”.
2013-01-06 01.06 AM22

Feb 27, 2013
One of my network colleagues happen to be using CTCA for her care and has this to say: “In 1 day at Cancer Treatment Centers of America they scheduled more diagnostics than what was possible at both ___ and ___ hospitals in months. I expect to know what’s what and options by close of business on Weds! This bodes well as I am not good at chewing cud!” — This is good feedback for the responsiveness of CTCA to this aspect of patient care.

Updated: June 30, 2013 — 8:03 am

2 Comments

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  1. Cancer Treatment Centers of America have high survival rates because they turn away the tough cases!

    See:
    http://www.reuters.com/article/2013/03/06/us-usa-cancer-ctca-idUSBRE9250L820130306

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