Ovarian cancer; Quality of care; Reference centres; Volume-outcome analyses; Oncology; Cancer Research
Abstract :
[en] [en] OBJECTIVES: To study the association between hospital volume and outcomes in patients with invasive epithelial ovarian cancer (EOC).
METHODS: This study included 3988 patients diagnosed with invasive EOC between 2014 and 2018, selected from the population-based database of the Belgian Cancer Registry (BCR), and coupled with health insurance and vital status data. The associations between hospital volume and observed survival since diagnosis were assessed with Cox proportional hazard models, while volume associations with 30-day post-operative mortality and complicated recovery were evaluated using logistic regression models.
RESULTS: Treatment for EOC was very dispersed with half of the 100 centres treating fewer than six patients per year. The median survival of patients treated in centres with the highest-volume quartile was 2.5 years longer than in those with the lowest-volume quartile (4.2 years versus 1.7 years). When taking the case-mix of hospitals into account, patients treated in the lowest volume centres had a 47% higher hazard to die than patients treated in the highest volume centres (HR: 1.47, 95% CI: 1.11-1.93, p = 0.006) over the first five years after incidence. A similar association was found when focussing on the surgical volume of the hospitals and considering only operated patients with invasive EOC. Lastly, the 30-day post-operative mortality decreased significantly with increasing surgical volume.
CONCLUSIONS: The large dispersion of care and expertise within Belgium and the volume-outcome associations observed in this study support the implementation of the concentration of care for patients with invasive EOC in reference centres.
Disciplines :
Oncology
Author, co-author :
Savoye, Isabelle ; Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium. Electronic address: isabelle.savoye@kce.fgov.be
Silversmit, Geert ; Belgian Cancer Registry, Brussels, Belgium
Bourgeois, Jolyce; Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
De Gendt, Cindy ; Belgian Cancer Registry, Brussels, Belgium
Leroy, Roos; Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
Peacock, Hanna M; Belgian Cancer Registry, Brussels, Belgium
Stordeur, Sabine; Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
de Sutter, Philippe ; Department Gynaecology-Oncology, UZ Brussel - VUB, Brussels, Belgium
Goffin, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Luyckx, Mathieu; Service de gynécologie et Andrologie and Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium
Orye, Guy; Department of Obstetrics and Gynecology, Jessa Hospital, Hasselt, Belgium
Van Dam, Peter ; Division of Gynecologic Oncology, Multidisciplinary Oncologic Center, Antwerp University Hospital, Edegem, Belgium
Van Gorp, Toon ; University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
Verleye, Leen ; Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. It was supported by the government approved work program of the Belgian Healthcare Knowledge Centre .
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