Abstract
Background
Care processes for patients with NSCLC can vary by provider, which may lead to unwanted
variation in outcomes. Therefore, in modern health care an increased focus on guideline
development and implementation is seen. It is expected that more guideline adherence
leads to a higher number of patients receiving optimal treatment for their cancer
which could improve overall survival.
Objective
The aim of this study was to evaluate variations in treatment patterns and outcomes
of patients with NSCLC treated in different (types of) hospitals and regions in the
Netherlands. Especially, variation in the percentage of patients receiving the optimal
treatment for the stage of their disease, according to the Dutch national guideline
of 2004, was analyzed.
Methods
All patients with a histological confirmed primary NSCLC diagnosed in the period 2001–2006
in all Dutch hospitals (N = 97) were selected from the population-based Netherlands Cancer Registry. Hospitals
were divided in groups based on their region (N = 9), annual volume of NSCLC patients, teaching status and presence of radiotherapy
facilities. Stage-specific differences in optimal treatment rates between (groups
of) hospitals and regions were evaluated.
Results
In the study period 43 544 patients were diagnosed with NSCLC. The resection rates
for stage I/II NSCLC patients increased during the study period, but resection rates
varied by region and were higher in teaching hospitals for thoracic surgeons (OR 1.5;
95%CI 1.2–1.9, p = 0.001) and in hospitals with a diagnostic volume of more than 50/year (OR 1.3;
95%CI 1.1–1.5, p = 0.001). Also the use of chemoradiation in stage III patients increased, though
marked differences between hospitals in the use of chemoradiation for stage III patients
were revealed. Differences in optimal treatment rates between hospitals led to differences
in survival.
Conclusion
Treatment patterns and outcome of NSCLC patients in the Netherlands varied by region
and the hospital their cancer was diagnosed in. Though resection rates were higher
in hospitals training thoracic surgeons, variation between individual hospitals was
much more distinct. Hospital characteristics like a high diagnostic volume, teaching
status or availability of radiotherapy facilities proved no guarantee for optimal
treatment rates.
Keywords
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Article info
Publication history
Accepted:
June 8,
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.
