Dutch Lung Surgery Audit: A National Audit Comprising Lung and Thoracic Surgery Patients

Berge, M. Ten; Beck, Naomi; Heineman, David J.; Damhuis, Ronald A.; Steup, W. H.; Huijstee, Pieter J. Van; Eerenberg, J. P.; Veen, Eelco J.; Maat, Alexander P.W.M.; Versteegh, Michel I.M.; Brakel, Thomas van; Schreurs, W. H.; Wouters, Michel W. J. M.

doi:10.1016/j.athoracsur.2018.03.049

Cited by 39 publications

(34 citation statements)

References 21 publications

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“…This retrospective cohort study evaluates outcomes of all patients with clinically suspected or pathologically proven NSCLC whom underwent complete clinical staging and surgical resection at the Radboudumc in the period January 2015 -April 2019. Patients were identified from the prospectively collected national DLCA-S database, containing all surgical procedures for lung and mediastinal disease at our hospital [31]. By this registry, hospital care quality, disease prevalence, survival and deaths are regularly compared from one hospital to the other.…”

Section: Methodsmentioning

confidence: 99%

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

et al. 2020

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Lymph node staging in patients with non-small cell lung cancer is crucial for determining prognosis and treatment. Our objective was to evaluate the clinical-to pathological agreement of guideline-concordant nodal staging in patients with resectable NSCLC and assess occurrence and distribution of occult lymph node metastases (OLM). Materials and methods: In a retrospective single center cohort study (n = 390), we analyzed all surgically treated NSCLC patients from January 2015 until April 2019. Patients were classified into subgroups (1) mediastinal staging by PET-CT/CT-scan (IMAGE-group) or (2) invasive staging by endobronchial ultrasound and mediastinoscopy (INVAS-group). Agreement between final clinical (cN) and pathological nodal stage (pN) and the presence and location of OLM are analyzed. Results: Agreement between cN-and pN-stage was 86.3 % in the IMAGE-group (n = 117) and 50.9 % in the INVAS-group (n = 167). Occult N1 disease was found in 33 patients (16.6 % in cN0) of which 52 % occurred in LN-regions 12− 14. Occult N2 disease was found in 20 cases (6.5 % in cN0 and 12.7 % in cN1). Combined, 23.1 % of all pre-operatively cN0-staged patients (n = 46/199) had OLM (pN+), of which 12.1 % (24/199) had metastases in regions 5-6 and/or 12− 14. Of all patients with OLM, 50.0 % (23/46) had primary tumors ≤30 mm. Conclusion: OLM are frequently identified in clinically N0/N1 NSCLC, also in tumors <3 cm, and often in regions beyond reach of current staging techniques. These findings should be addressed when non-surgical treatment or sub-lobar resections are considered for early stage lung cancer.

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Section: Methodsmentioning

confidence: 99%

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

et al. 2020

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“…In 2012, the Dutch Lung Cancer Audit for Surgical treatment (DLCA-S) was initiated, which became a mandatory registry in 2015, leading to a nationwide population-based registry in the Netherlands [13]. The DLCA-S does not include radiotherapy and systemic treatment of lung cancer patients.…”

Section: Introductionmentioning

confidence: 99%

The Dutch Lung Cancer Audit: Nationwide quality of care evaluation of lung cancer patients

et al. 2020

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This study describes the initiation of the Dutch Lung Cancer Audit for Lung Oncology (DLCA-L) and reports the first results of three years of clinical auditing. Methods: The initiation, dataset, and data quality of the DLCA-L are described. For the analyses, all patients registered from 2017 to 2019 were included. Descriptive statistics were used to assess the first outcomes of the DLCA-L, including results from quality indicators, patient-and tumor characteristics, and the real-world use of immunotherapy. Results: The DLCA-L was initiated after the surgery and radiotherapy audit for lung cancer. In total, 33.788 NSCLC patients and 4.293 SCLC patients were registered in the DLCA-L from 2017 to 2019. Seventy-three (97 %) Dutch hospitals participated in the DLCA-L in 2019. The registry became nationwide in 2020. The data quality improved over the years, with complete cases in 90 % of the NSCLC patients. In total, 15 quality indicators were established based on DLCA-L data to improve processes and clinical outcomes. An example of these quality indicators was brain imaging at diagnosis of stage III NSCLC patients, which increased from 80 % in 2017 to 90 % in 2019 and hospital variation was reduced. The DLCA-L provided data on immunotherapy use in stage IV NSCLC (n = 4.415) patients. These patients had a median age of 67 years and 11 % of the patients had an ECOG PS ≥ 2. The number of patients treated with immunotherapy in different hospitals varied between 2 patients to 163 patients per hospital. Conclusion: The DLCA-L has become a valuable and complete data source with national coverage in 2020. A high number of registered patients and limited missing data resulted in better insights into hospital processes and outcomes of lung cancer care. Quality indicators were, with success, used to establish improvements and minimize hospital variation. The DLCA-L also provides hospitals real-world information on the use of (systemic) therapies.

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“…The development of the DLCA was facilitated by DICA and design was in accordance with the DICA blueprint (6). In 2012 the first national quality registry on lung cancer was initiated, focussing on surgical treatment: the Dutch Lung Surgery Audit (7). In The Netherlands, lung surgery is performed by cardiothoracic surgeons and by general surgeons with a specialization in lung surgery.…”

Section: Developmentmentioning

confidence: 99%

“…The pulmonologists joined the DLCA-L only recently and the number of analysable patients with NSCLC included in this sub-registry in 2016 is limited to 35-40 percent of the national incidence (2). It is expected that case ascertainment will rapidly increase over time, especially from the moment hospitals are provided with benchmarked feedback (6,7,20,21). The great incentive for clinicians to participate in the audit is the information they receive on the quality of their performance in clinical practice with indicator results benchmarked to the national average (intrinsic motivation).…”

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confidence: 99%

Lessons learned from the Dutch Institute for Clinical Auditing: the Dutch model for quality assurance in lung cancer treatment

Beck¹,

Hoeijmakers²,

Wiegman³

et al. 2018

J. Thorac. Dis

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Background: Quality registries play an important role in the professional quality system for cancer treatment in The Netherlands. This article provides insight into the Dutch Lung Cancer Audit (DLCA); its core principles, initiation and development, first results and what lessons can be learned from the Dutch experience. Methods: Cornerstones of the DLCA are discussed in detail, including: audit aims; the leading role for clinicians; web-based registration and feedback; data handling; multidisciplinary evaluation of quality indicators; close collaborations with all stakeholders in healthcare and transparency of results. Results: In 2012 the first Dutch lung cancer specific sub-registry, focusing on surgical treatment was started. Since 2016 all major treating specialisms (lung oncologists, radiation-oncologists, general-and cardiothoracic surgeons-represented in the DLCA-L,-R and-S sub-registries respectively) have joined. Over time, the number of participating hospitals and included patients has increased. In 2016, the numbers of included patients with a non-small cell lung cancer (NSCLC) were 3,502 (DLCA-L), 2,427 (DLCA-R) and 1,979 (DLCA-S). Between sub-registries mean age varied from 66 to 70 years, occurrence of Eastern Cooperative Oncology Group (ECOG) performance score 2+ varied from 3.3% to 20.8% and occurrence of clinical stage I-II from 27.6% to 81.3%. Of all patients receiving chemoradiotherapy 64.2% was delivered concurrently. Of the surgical procedures 71.2% was started with a minimally invasive technique, with a conversion rate of 18.7%. In 2016 there were 17 publicly available quality indicators-consisting of structure, process and outcome indicators-calculated from the DLCA. Conclusions: the DLCA is a unique registry to evaluate the quality of multidisciplinary lung cancer care. It is accepted and implemented on a nationwide level, enabling participating healthcare providers to get insight in their performance, and providing other stakeholders with a transparent evaluation of this performance, all aiming for continuous healthcare improvement.

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Dutch Lung Surgery Audit: A National Audit Comprising Lung and Thoracic Surgery Patients

Cited by 39 publications

References 21 publications

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

The Dutch Lung Cancer Audit: Nationwide quality of care evaluation of lung cancer patients

Lessons learned from the Dutch Institute for Clinical Auditing: the Dutch model for quality assurance in lung cancer treatment

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