Abstract
Aim
To describe the population-based variation in treatment policies and outcome for bladder
cancer in the Netherlands.
Methods
All newly diagnosed patients with primary bladder cancers during 2001–2006 were selected
from the Netherlands Cancer Registry (n = 29,206). Type of primary treatment was analysed according to Comprehensive Cancer
Centre region, hospital type (academic, non-academic teaching or other hospitals)
and volume (≤5, 6–10 or >10 cystectomies yearly). For stage II–III patients undergoing
cystectomy we analyzed the proportion of lymph node dissections and 30-days mortality.
Results
44% of patients with stage II–III bladder cancer underwent cystectomy, while 26% were
not treated with curative intent. Cystectomy was the preferred option in three of
nine regions, radiotherapy in two, and two regions waived curative treatment more
often. Between 2001 and 2006 the number of cystectomies increased with 20% (n = 108). Twenty-one percent (n = 663) of these procedures were performed in 44 low-volume hospitals. In 79% of the
cystectomies lymph node dissections were performed, more often in high and medium-volume
centers (82% and 81% respectively) than in low-volume hospitals (71%, the odds ratio
being 1.5). The overall 30-days post-operative mortality rate was 3.4% and increased
with older age. It was significantly lower in high-volume centers (1.2%).
Conclusion
Treatment policies for muscle-invasive bladder cancer in the Netherlands showed regional
preferences and a gradual increase of cystectomy. Cystectomy albeit considered as
golden standard, was performed in a minority of the muscle-invasive cases. In high-volume
institutions, lymph node dissection rates were higher and post-operative mortality
rates were lower.
Keywords
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Article info
Publication history
Accepted:
June 1,
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.
