Abstract
Background
Aim of this study was to describe treatment patterns and outcome according to region,
and according to hospital types and volumes among patients with colon cancer in the
Netherlands.
Methods
All patients with invasive colon carcinoma diagnosed in the period 2001–2006 were
selected from the Netherlands Cancer Registry. Logistic regression analyses were performed
to examine the influence of relevant factors on the odds of having adequate lymph
node evaluation, receiving adjuvant chemotherapy and postoperative mortality. Relative
survival analysis was used to estimate relative excess risk of dying according to
hospital type and volume.
Results
In total, 39 907 patients were selected. Patients diagnosed in a university hospital
had a higher odds (OR 2.47; 95% CI 2.19–2.78) and patients diagnosed in a hospital
with >100 colon carcinoma diagnoses annually had a lower odds (OR 0.70; 95% CI 0.64–0.77)
of having ≥10 lymph nodes evaluated. The odds of receiving adjuvant chemotherapy was
lower in patients diagnosed in teaching hospitals (OR 0.85; 95% CI 0.73–0.98) and
university hospitals (OR 0.56; 95% CI 0.45–0.70) compared to patients diagnosed in
non-teaching hospitals. Funnel plots showed large variation in these two outcome measures
between individual hospitals. No differences in postoperative mortality were found
between hospital types or volumes. Patients diagnosed in university hospitals and
patients diagnosed in hospitals with >50 diagnoses of colon carcinoma per year had
a better survival.
Conclusions
Variation in treatment and outcome of patients with colon cancer in the Netherlands
was revealed, with differences between hospital types and volumes. However, variation
seemed mainly based on the level of the individual hospital.
Keywords
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Article info
Publication history
Accepted:
May 27,
2010
Footnotes
☆Study performed by the ‘Quality of cancer care’ taskforce of the Signalling Committee Cancer of the Dutch Cancer Society (the committees full report is available on www.kwfkankerbestrijding.nl).
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
