Abstract
Background
Aim of this study was to describe treatment patterns and outcome according to region
and hospital type and volume among patients with rectal cancer in the Netherlands.
Methods
All patients with rectal 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 receiving preoperative
radiotherapy and on the odds of postoperative mortality. Relative survival analysis
was used to estimate relative excess risk of dying according to hospital type and
volume.
Results
In total, 16 039 patients were selected. Patients diagnosed in a teaching or university
hospital had a lower odds (OR 0.85; 95% CI 0.73–0.99 and OR 0.70; 95% CI 0.52–0.92)
and patients diagnosed in a hospital performing >50 resections per year had a higher
odds (OR 1.95; 95% CI 1.09–1.76) of receiving preoperative radiotherapy. A large variation
between individual hospitals in rates of preoperative radiotherapy and between Comprehensive
Cancer Centre-regions in the administration of preoperative chemoradiation was revealed.
Postoperative mortality was not correlated to hospital type or volume. Patients with
T1-M0 tumours diagnosed in a hospital with >50 resections per year had a better survival
compared to patients diagnosed in a hospital with <25 resections per year (RER 0.11;
95% CI 0.02–0.78).
Conclusion
This study demonstrated variation in treatment and outcome of patients with rectal
cancer in the Netherlands, with differences related to hospital volume and hospitals
teaching or academic status. However, variation in treatment patterns between individual
hospitals proved to be much larger than could be explained by the investigated characteristics.
Future studies should focus on the reasons behind these differences, which could lead
to a higher proportion of patients receiving optimal treatment for their stage of
the disease.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hospital volume and surgical mortality in the United States.N Engl J Med. 2002; 346: 1128-1137
- Surgeon volume and operative mortality in the United States.N Engl J Med. 2003; 349: 2117-2127
- A systematic review of the impact of volume of surgery and specialization on patient outcome.Br J Surg. 2007; 94: 145-161
- ([accessed 18.05.09])
- ([accessed 03.05.09])
- Improved overall survival for patients with rectal cancer since 1990: the effects of TME surgery and pre-operative radiotherapy.Eur J Cancer. 2008; 44: 1710-1716
- Improved survival of patients with rectal cancer since 1980: a population-based study.Eur J Cancer. 2003; 39: 2073-2079
- Guideline rectal cancer.([accessed 10.06.09])
- Population-based study of trends and variations in radiotherapy as part of primary treatment of cancer in the southern Netherlands between 1988 and 2006, with an emphasis on breast and rectal cancer.Int J Radiat Oncol Biol Phys. 2009; 74: 464-471
- The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer.Surgery. 2002; 131: 6-15
- Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands.Ann Surg. 2005; 242: 781-788
- High-volume versus low-volume for esophageal resections for cancer: the essential role of case-mix adjustments based on clinical data.Ann Surg Oncol. 2008; 15: 80-87
- Influence of hospital volume on local recurrence and survival in a population sample of rectal cancer patients.Eur J Surg Oncol. 2005; 31: 512-520
- Hospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population.J Gastrointest Surg. 2000; 4: 324-330
- Relation of hospital volume to colostomy rates and survival for patients with rectal cancer.J Natl Cancer Inst. 2003; 95: 708-716
- Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery at a national level.Br J Surg. 2005; 92: 217-224
- Variations in treatment of rectal cancer: the influence of hospital type and caseload.Dis Colon Rectum. 1997; 40: 641-646
- Survival after rectal cancer: differences between hospital catchment areas. A nationwide study in Sweden.Gut. 1999; 45: 39-44
- Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario.Can J Surg. 2006; 49: 251-258
- Incidence of cancer in the Netherlands 1998.Vereniging van Integrale Kankercentra, Utrecht2002
- International classification of diseases for oncology.3rd ed. WHO, Geneva2000
- Wittekind C. Greene F.L. Hutter R.V.P. Klimpfinger M. Sobin L.H. TNM atlas. 5th ed. Springer-Verlag, Berlin2004
- Quality of cancer registry data: a comparison of data provided by clinicians with those of registration personnel.Br J Cancer. 1993; 68: 974-977
- Completeness of cancer registration in Limburg, The Netherlands.Int J Epidemiol. 1993; 22: 369-376
- ([accessed 10.05.10])
- Approximate is better than “exact” for interval estimation of binomial proportions.The American Statistician. 1998; 52: 119-126
- Funnel plots for comparing institutional performance.Stat Med. 2005; 24: 1185-1202
- Instructions to IBM 650 programmers in processing survival computations.National Cancer Institute, Bethesda, MD1959
- Changes in the practice of adjuvant radiotherapy in resectable rectal cancer within a French well-defined population.Radiother Oncol. 2000; 57: 137-142
- A survey on the impact of operation volume on rectal cancer management.J Korean Med Sci. 2007; 22: S86-S90
- Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence. Part 1: short-term outcome.Colorectal Dis. 2007; 9: 28-37
- Surgeon and hospital volume and the management of colorectal cancer patients in Australia.ANZ J Surg. 2005; 75: 901-910
- Relation of surgeon and hospital volume to processes and outcomes of colorectal cancer surgery.Ann Surg. 2006; 244: 1003-1011
- Chemotherapy with preoperative radiotherapy in rectal cancer.N Engl J Med. 2006; 355: 1114-1123
- Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203.J Clin Oncol. 2006; 24: 4620-4625
- Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer prognosis than younger patients: a population-based study.Eur J Cancer. 2006; 42: 3015-3021
- Controversies of total mesorectal excision for rectal cancer in elderly patients.Lancet Oncol. 2008; 9: 494-501
- Population-based study of risk factors for postoperative death after anterior resection of the rectum.Br J Surg. 2006; 93: 498-503
- Risk factors for anastomotic leakage after resection of rectal cancer.Br J Surg. 1998; 85: 355-358
- Hospital caseload and the results achieved in patients with rectal cancer.Br J Surg. 2001; 88: 1397-1402
- The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma.Ann Surg. 2007; 246: 693-701
- Impact of hospital procedure volume on surgical operation and long-term outcomes in high-risk curatively resected rectal cancer: findings from the Intergroup 0114 Study.J Clin Oncol. 2004; 22: 166-174
- The case against volume as a measure of quality of surgical care.World J Surg. 2005; 29: 1222-1229
Article info
Publication history
Accepted:
June 10,
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.
