Secrets of a Top American Cancer Center

Nick Mulcahy

March 28, 2012

March 28, 2012 — In 1944, a state oncology hospital that was partly funded by a charity opened its doors on a rehabbed but still rat-infested property in Houston, Texas. Some 70 years after that inauspicious start, the University of Texas M.D. Anderson Cancer Center is rated the number 1 American cancer hospital by the US News & World Report.

The story of M.D. Anderson's transition from an unwanted public hospital to a preeminent cancer center is the subject of Making Cancer History by historian James Olson, PhD (Johns Hopkins Press).

The book, which is an institutional history, is also a kind of how-to guide to becoming a top cancer center. It describes many of the key decisions and cultural values that fueled M.D. Anderson's rise to greatness.

The top ranking would have delighted Lee Clark, MD, the surgeon who took charge of the center in 1946, said Dr. Olson, who is a professor of history at Sam Houston State University in Huntsville, Texas.

"Dr. Clark thought about being the top cancer center in America every day," Dr. Olson told Medscape Medical News.

"I'm certain that he rolled over in his grave and tried to stand up" when the top ranking was first achieved, said Dr. Olson, an eclectic historian whose books include a best-selling biography of John Wayne and a history of breast cancer.

Dr. Clark was "quite calculated" in his pursuit of making the center the most renowned in the United States. Soon after starting his job, he went to New York City to visit the mighty Memorial Hospital for Cancer and Allied Diseases.

"For years, Lee Clark would measure M.D. Anderson against the Memorial standard," writes Dr. Olson.

It's taken very, very seriously.

And even after Dr. Clark retired, his successors have kept a close eye on the competition, said Dr. Olson. The US News rankings are a big part of that. "It's taken very, very seriously," said Dr. Olson.

Elite hospitals can have a schizophrenic attitude about the US News rankings, said Avery Comarow, the editor of the hospital rankings. "The elite hospitals often like to dismiss the rankings as irrelevant and unnecessary," he told Medscape Medical News. But they also "pay close attention to them," he said.

The US News Web site reports that the hospital rankings started in 1990 as a tool for patients in need of "unusually skilled" inpatient care. "That mission hasn't changed in Year 22," reads the site.

The Best Hospitals rankings are grounded in a scoring system with 4 elements: survival (which is adjusted for morbidity and accounts for 32.5% of the score); patient safety (5%); reputation (based on a survey of specialists; 32.5%); and other care measures such as technology and patient/nurse ratios (30%).

"Many clinicians hate the inclusion of reputation," said Comarow.

M.D. Anderson is savvy about such important matters, explained Dr. Olson. "M.D. Anderson has cultivated its reputation," he said, especially among physicians. For a time in the 1970s, the institution lost some of its luster among referring physicians. However, under the direction of Charles LaMaistre, MD, who took over as the top executive in 1978, relationships and opinions were "carefully cultivated" and "restored," said Dr. Olson.

Again and Again and Again

M.D. Anderson's reputation is not simply the result of the long-held ambitions of its top administrators and skilled public relations. It is grounded in the fundamentals of good cancer care, said Dr. Olson, who left no stone unturned in examining that culture.

Dr. Olson took 8 years to write his book, accessing 100,000 different documents and interviewing 400 people, from top administrators and researchers to janitorial staff and accountants.

In going through thousands of hospital documents, including evaluations and accreditations from the National Institutes of Health and the American Hospital Association, Dr. Olson found "praise for patient care again and again and again."

Part of the philosophy of patient care includes Dr. Clark's belief that the adverse effects of treatment are very important, said Dr. Olson. "From day 1...he insisted that he would not engage a new technology unless the staff could handle the side effects."

M.D. Anderson is "top notch in patient care" and has "always claimed to be the best," said Dr. Olson. He is a believer, having been a patient at M.D. Anderson off and on since the early 1980s. Dr. Olson, who is from a family with a cancer syndrome history, has had sarcomas, brain cancer, melanoma, and most recently prostate cancer. His history of M.D. Anderson is a "labor of love" because of his debt of gratitude. It is also an unusual history: "I wrote myself into the narrative."

Dr. Olson admits that he is not a dispassionate historian; his history is full of institutional warts, including accounts of its cooperation with the Jim Crow laws of the American South that segregated blacks and whites.

But the rise of M.D. Anderson overshadows its shortcomings in this history book. Dr. Clark was a pivotal administrator who "made no small plans," writes Dr. Olson.

Not every patient who has been seen at M.D. Anderson walks away happy. The book describes the difficult experience of professional cyclist Lance Armstrong, who was diagnosed with testicular cancer and lung and brain metastases and sought an opinion there. But even Armstrong, who was ultimately treated at Indiana University, eventually happily worked with M.D. Anderson staff as part of his cancer foundation work.

Another contributor to the greatness of M.D. Anderson is the very real commitment to team culture, explained Dr. Olson. In a fact-finding interview, a janitor, who is a long-time employee, told Dr. Olson that Dr. Clark made all staff feel that they were, in doing their jobs well, part of the effort to cure cancer.

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