The quality of cancer care initiative in the Netherlands

Wouters, Michel W. J. M.; Jansen-Landheer, M.L.E.A.; Velde, C.J.H. van de

doi:10.1016/j.ejso.2010.06.004

Cited by 50 publications

(41 citation statements)

References 113 publications

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“…Optimally, cancer treatment centers encompass a specialized environment with the proper infrastructure, sufficient volume, and adequate expertise with quality improvement protocols designed for continual evaluation and enhancement (17). High volume hospitals additionally may better provide team-based expertise for complex cases, physicians specialized in the diagnosis and treatment of rare cancer types, and a centralized method for delivering complex medical and surgical care.…”

Section: Discussionmentioning

confidence: 99%

Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

Melvan

Sancheti

Gillespie

et al. 2015

Journal of the American College of Surgeons

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Background Clinical variables associated with 30-day mortality after lung cancer surgery are well known. However, the effects of non-clinical factors, including insurance coverage, household income, education, type of treatment center, and area of residence, on short term survival are less appreciated. We studied the National Cancer Data Base (NCDB), a joint endeavor of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, to identify disparities in 30-day mortality after lung cancer resection based on these non-clinical factors. Study Design We performed a retrospective cohort analysis of patients undergoing lung cancer resection from 2003-2011, using the NCDB. Data were analyzed using a multivariable logistic regression model to identify risk factors for 30-day mortality. Results 215,645 patients underwent lung cancer resection during our study period. We found that clinical variables such as age, gender, comorbidity, cancer stage, preoperative radiation, extent of resection, positive surgical margins, and tumor size were associated with 30-day mortality after resection. Non-clinical factors including living in lower income neighborhoods with a lesser proportion of high school graduates, and receiving cancer care at a non-academic medical center were also independently associated with increased 30-day postoperative mortality. Conclusions This study represents the largest analysis of 30-day mortality for lung cancer resection to date from a generalizable national cohort. Our results demonstrate that, in addition to known clinical risk factors, several non-clinical factors are associated with increased 30-day mortality after lung cancer resection. These disparities require further investigation to improve lung cancer patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

Melvan

Sancheti

Gillespie

et al. 2015

Journal of the American College of Surgeons

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“…It has been recommended that for optimal quality of cancer care, “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.”26 All surgeons involved in this study have subspecialized practices focusing on breast cancer surgery. Although no studies have been done to directly examine the relationship between surgical expertise and pain outcomes, Kehlet27 suggests that “nerve injury might be reduced by surgical expertise,” thus reducing the risk of PPP.…”

Section: Discussionmentioning

confidence: 99%

Reducing Persistent Postoperative Pain and Disability 1 Year After Breast Cancer Surgery: A Randomized, Controlled Trial Comparing Thoracic Paravertebral Block to Local Anesthetic Infiltration

et al. 2013

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BackgroundThe objective of this study was to compare the effect of thoracic paravertebral block (TPVB) and local anesthetic (LA) on persistent postoperative pain (PPP) 1 year following breast cancer surgery. Secondary objectives were to compare the effect on arm morbidity and quality of life.MethodsWomen scheduled for elective breast cancer surgery were randomly assigned to either TPVB or LA followed by general anesthesia. An NRS value of >3 at rest or with movement 1 year following surgery defined PPP. Blinded interim analysis suggested rates of PPP much lower than anticipated, making detection of the specified 20 % absolute reduction in the primary outcome impossible. Recruitment was stopped, and all enrolled patients were followed to 1 year.ResultsA total of 145 participants were recruited; 65 were randomized to TPVB and 64 to LA. Groups were similar with respect to demographic and treatment characteristics. Only 9 patients (8 %; 95 % CI 4–14 %) met criteria for PPP 1 year following surgery; 5 were in the TPVB and 4 in the LA group. Brief Pain Inventory severity and interference scores were low in both groups. Arm morbidity and quality of life were similar in both groups. The 9 patients with PPP reported shoulder-arm morbidity and reduced quality of life.ConclusionsThis study reports a low incidence of chronic pain 1 year following major breast cancer surgery. Although PPP was uncommon at 1 year, it had a large impact on the affected patients’ arm morbidity and quality of life.

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“…A study on the management of cervical cancer found a positive association between the number of patients treated and successful outcomes [34]. A working group created by the Dutch Cancer Society to evaluate the quality of care for cancer patients concluded that complex or high-risk cancer procedures should be provided in a specialised setting, with proper infrastructure, suffi cient volume and adequate expertise [35]. Another study [36] found that men treated with BT by higher volume physicians were at lower risk for recurrence and prostate cancer death, with a decrease in total deaths; however, these authors did not fi nd a clear relationship between provider volume and complications following treatment.…”

Section: Volume Of Patients Treatedmentioning

confidence: 99%

Patterns of care for brachytherapy in Europe: updated results for Spain

et al. 2012

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The three most common treatment sites (gynaecological, breast and prostate) remain unchanged from 2002, with prostate treatments showing large increase. Advanced dosimetric techniques (MRI, PET-CT and CT-dosimetry) continue to gain adherents. Some centres treat small numbers of patients, a finding that deserves more attention in terms of cost and quality of care. Although BT remains strong in Spain, it could be further strengthened by making modern dosimetric techniques and treatments more widely available.

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The quality of cancer care initiative in the Netherlands

Cited by 50 publications

References 113 publications

Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

Reducing Persistent Postoperative Pain and Disability 1 Year After Breast Cancer Surgery: A Randomized, Controlled Trial Comparing Thoracic Paravertebral Block to Local Anesthetic Infiltration

Patterns of care for brachytherapy in Europe: updated results for Spain

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