Disparities in quality of care for colon cancer between hospitals in the Netherlands

Elferink, M.A.G.; Wouters, Michel W. J. M.; Krijnen, Pieta; Lemmens, Valery; Jansen-Landheer, M.L.E.A.; Velde, Cornelis J.H. van de; Siesling, Sabine; Tollenaar, Rob A.E.M.

doi:10.1016/j.ejso.2010.05.026

Cited by 43 publications

(38 citation statements)

References 41 publications

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“…Op basis van de gegevens in de Nederlandse Kanker Registratie (NKR) werd een aantal tumorsoorten onderzocht, waaronder spierinvasief blaascarcinoom, maar ook mamma-, colorectaal-en longcarcinoom [2][3][4][5][6]. Verschillen in uitkomsten van zorg bleken aanzienlijk, maar tegelijkertijd nauwelijks te duiden, omdat essentiële gegevens betreffende patiënt-, tumor-en behandelingskarakteristieken in de NKR ontbraken.…”

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Kwaliteitsregistraties volgens het principe van ‘clinical auditing’

Wouters

2017

Tijdschr Urol

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Samenvatting Wetenschappelijke verenigingen van medisch specialisten hebben de afgelopen jaren kwaliteitsregistraties geïnitieerd die zijn opgezet volgens het clinical-auditing principe. Het primaire doel van deze landelijke audits is het verbeteren van zorguitkomsten, door behandelaars te voorzien van spiegelinformatie, waarmee zij de kwaliteit van hun zorgproces kunnen monitoren en verbeteren. Directe betrokkenheid van dokters bij de opzet en uitvoering van de audit, tijdige terugkoppeling van kwaliteitsaspecten die door henzelf belangrijk worden gevonden en het proactief volgen van ontwikkelingen in de zorg, zijn essentieel voor het succes van kwaliteitsregistraties. De mogelijkheid voor behandelaars om resultaten te monitoren, richtlijnnavolging en de introductie van de mogelijkheid om nieuwe technieken te evalueren en met kwaliteitsintiatieven hun uitkomsten te verbeteren, heeft tot substantiële vermindering van morbiditeit en mortaliteit geleid op diverse chirurgische terreinen. Registratie aan de bron, structurele financiering en goede afspraken over transparantie, zijn essentieel om clinical auditing te bestendigen als krachtig instrument in het kwaliteitsbeleid van wetenschappelijke verenigingen.

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Kwaliteitsregistraties volgens het principe van ‘clinical auditing’

Wouters

2017

Tijdschr Urol

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“…Based on our findings either relation is possible, but we tend to conclude that quality focussed hospitals are more likely to work on continuous quality improvement and to behave as early adopters. Inter-hospital and regional variation in the treatment of colorectal cancer patients was shown in previous national studies [Elferink et al, 2010b, Elferink et al, 2010c. Before 2000 there was both regional variation in guidelines and in their implementation in the Netherlands.…”

Section: Discussionmentioning

confidence: 96%

“…The results in our study may also have been influenced by clinical trials conducted before official guideline recommendation. However, despite possible guideline and trial influences, recent studies still stress the patientand hospital-dependant variation in adjuvant therapy, even after official guideline introduction of new therapies in the Netherlands and it is unlikely that this is different in other countries [Berrino et al, 2007, Elferink et al, 2010b, Elferink et al, 2010c, Lemmens et al, 2005, van Steenbergen et al, 2010b. Although it is unlikely that guideline and trial influences alone can explain the treatment variation, it is very difficult to correct for these factors in studying the impact of peer review.…”

Section: Discussionmentioning

confidence: 97%

“…Pathological stage was used for analysing the use of adjuvant chemotherapy in stage III colon cancer and survival, clinical stage was used when pathological stage was unknown. We excluded patients aged ≥75 years for the analyses of the introduction of chemotherapy in stage III colon cancer and chemoradiation in T4/M0 rectal cancer to prevent a bias as elderly patients are known to receive systemic therapy less frequently [Elferink et al, 2010b, Elferink et al, 2010c.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Studies have proven that regional and inter-hospital treatment variation exists that cannot be explained by medical factors only. It is suggested that hospital characteristics have a role in this variation [Elferink et al, 2010b, Elferink et al, 2010c. Three major therapy changes requiring multidisciplinary cooperation have been introduced in the period under study: (1) the introduction of adjuvant chemotherapy in stage III colon cancer, (2) the introduction of preoperative radiotherapy in T2-T3 rectal cancer and (3) the introduction of preoperative chemoradiation in T4/M0 rectal cancer and tumours with an expected positive circumferential margin (CRM).…”

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confidence: 99%

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The value of external peer review in oncology : evaluating the impact on cancer services in Dutch hospitals

Kilsdonk¹

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Adjuvant Chemotherapy Use Among Older Patients With Stage III Colon Cancer

Moore¹,

Gibbs²

2010

JAMA

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colleagues 1 explored the use of adjuvant treatment in older patients with stage III colon cancer, with results that appear to suggest that oxaliplatin is being underused and too few patients are treated. However, we believe their findings may be consistent with appropriate treatment of the older population in routine care, based on available evidence and further consideration of the complexities of this patient group.The authors suggested that the limited use of oxaliplatin, especially for older patients, differs substantially from guidelines. However, current guidelines advise that capecitabine or fluorouracil alone are acceptable treatment options for stage III colon cancer. Furthermore, recent adjuvant studies have failed to demonstrate that adding oxaliplatin is of benefit for older patients, 2 and use of this agent in this group remains controversial.In prospective data collected on clinician and patient decision making for stage III colon cancer, 3 age alone was rarely the reason that treatment was not pursued, and this appears only to become a major factor in patients older than 80 years. In a survey of US clinicians, 4 92.6% of oncologists would recommend treatment for a fit 80-year-old patient with stage III colon cancer. This decreased to 47.2% for a patient with moderate comorbidities, with only 9.0% recommending treatment for those with severe comorbidities. Among older patients in the study by Kahn et al, 40% had moderate or severe comorbidities and 26% had a cancer history, likely reducing life expectancy and/or complicating treatment delivery.Another issue is that patients must be alive to receive treatment, and operative mortality in older patients is in excess of 10%. 5 When the significant proportion of older patients who may decline recommended treatment 3 is also considered, the number of treatment candidates is further reduced, suggesting that the proportion of the older population in whom treatment should be pursued is considerably less than 100%.We would conclude that therapy decisions regarding older patients are complex, with survey and routine care data suggesting only a small minority of patients are not treated solely on the basis of advanced age. In order to inform clinical decision making, studies need to address the key question of what percentage of patients older than 75 years should be receiving chemotherapy. Ultimately, 50% of older patients being treated may be consistent with good clinical practice.

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Disparities in quality of care for colon cancer between hospitals in the Netherlands

Abstract: Background.

Cited by 43 publications

References 41 publications

Kwaliteitsregistraties volgens het principe van ‘clinical auditing’

Kwaliteitsregistraties volgens het principe van ‘clinical auditing’

The value of external peer review in oncology : evaluating the impact on cancer services in Dutch hospitals

Adjuvant Chemotherapy Use Among Older Patients With Stage III Colon Cancer

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