Abstract
Background
In 2007 the Dutch Cancer Society formed a ‘Quality of Cancer Care’ taskforce comprising
medical specialists, from all disciplines involved in the care for cancer patients.
This taskforce was charged with the evaluation of quality of cancer care in the Netherlands
and the development of strategies for improvement.
Objective
The experts first focused on the relation between procedural volume and patient outcome
and later aimed to identify other factors associated with high and low quality of
the care provided in different regions and (types of) hospitals in the Netherlands.
The question if cancer care in the Netherlands could be organized differently to assure
high quality of care for all patients, was the main subject of investigation.
Methods
An extensive review of the literature on infrastructure, volume and specialization
on the one hand and outcome on the other was performed. In addition, a meta-analysis
of the volume–outcome relationship for pancreatectomies, bladder, lung, colorectal
and breast cancer resections was performed. Finally, variation in quality of cancer
care between regions, groups of hospitals and individual hospitals in our country
was investigated on data from the Netherlands Cancer Registry.
Results
In the Netherlands quality of care varies by hospital and region. These differences
are not limited to surgical procedures and postoperative mortality, but are also demonstrated
in other parts of the care process. Differences are only partly explained by differences
in infrastructure, procedural volume and specialization between hospitals. Essential
information on differences in case mix between these hospitals are lacking from the
Netherlands Cancer Registry. More detailed clinical data are needed to reveal the
mechanisms behind the differences in quality of care between Dutch hospitals.
Conclusion
On a population level, there is potential for improvement of outcome for cancer patients
in the Netherlands by reducing variation in optimal treatment rates between hospitals.
Not only treatment of tumours with a low incidence but also other complex or high
risk cancer procedures should be provided in a specialized setting, with the right
infrastructure, sufficient volume and adequate expertise. In addition, outcomes should
be monitored continuously and fed back to individual caregivers.
Keywords
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Article info
Publication history
Accepted:
June 1,
2010
Footnotes
☆On behalf of the ’Quality of cancer care’ task force 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.
