Adjuvant treatment; Diagnostic work-up; Endometrial cancer; Pathology; Patterns of care; Population-based; Quality of care; Staging; Surgical treatment; Time trends; Treatment patterns; Uterine cancer; Oncology; Obstetrics and Gynecology
Abstract :
[en] [en] OBJECTIVES: To investigate the practice patterns and quality of care for uterine cancer on a national level in Belgium, including trends in practice over the period 2012-2016.
METHODS: Quality indicators were measured using the EFFectiveness of Endometrial Cancer Treatment (EFFECT) database. Multivariable logistic mixed regression was used to test for associations between the quality indicators and year of diagnosis, adjusted for potential confounders and intra-cluster correlations.
RESULTS: The EFFECT database includes 4178 patients diagnosed with uterine cancer in the period 2012-2016. Minimally invasive surgery (laparoscopic or robotic-assisted) was applied in 61.6% of patients who had surgery for clinical stage I endometrial carcinoma (EC), increasing from 52.9% in 2012 to 66.4% in 2016. At least pelvic lymph node staging was performed in 69.0% of patients with clinical stage I, high-grade EC; and in 63.9% of patients with clinical stage I-II serous carcinoma, clear cell carcinoma or carcinosarcoma. The latter increased from 48.8% in 2012 to 77.2% in 2016. Adjuvant radiotherapy (external beam and/or brachytherapy) was offered to 33.5% of patients who had surgery without lymph node staging for pathological stage I EC at high-intermediate or high risk of recurrence. Adjuvant chemotherapy was administered to 64.4% of patients with pathological stage III-IVA EC.
CONCLUSIONS: Study results indicate an overall good quality of care for patients with uterine cancer in Belgium. Treatment areas with potential room for improvement include the use of minimally invasive surgery, comprehensive surgical staging and adjuvant therapy, which confirms the remaining controversies in uterine cancer treatment and the need for further research.
Disciplines :
Oncology
Author, co-author :
Vanbraband, Joren; Unit of Gynecologic Oncology, Department of Oncology, KU Leuven, Campus Gasthuisberg, ON4 Herestraat 49, Box 1045, 3000 Leuven, Belgium. Electronic address: joren.vanbraband@kuleuven.be
Van Damme, Nancy; Belgian Cancer Registry, Koningsstraat 215, Box 7, 1210 Brussels, Belgium. Electronic address: Nancy.VanDamme@kankerregister.org
Silversmit, Geert; Belgian Cancer Registry, Koningsstraat 215, Box 7, 1210 Brussels, Belgium. Electronic address: geert.silversmit@kankerregister.org
De Geyndt, Anke; Belgian Cancer Registry, Koningsstraat 215, Box 7, 1210 Brussels, Belgium. Electronic address: Anke.DeGeyndt@kankerregister.org
Jacomen, Gerd; Laboratory of Pathological Anatomy, AZ Sint-Maarten, Liersesteenweg 435, 2800 Mechelen, Belgium. Electronic address: Gerd.Jacomen@emmaus.be
de Jonge, Eric; Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Campus Sint-Jan, Synaps Park 1, 3600 Genk, Belgium. Electronic address: Eric.DeJonge@zol.be
Goffin, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Denys, Hannelore; Department of Medical Oncology, University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium. Electronic address: Hannelore.Denys@UGent.be
Amant, Frédéric; Unit of Gynecologic Oncology, Department of Oncology, KU Leuven, Campus Gasthuisberg, ON4 Herestraat 49, Box 1045, 3000 Leuven, Belgium, Department of Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands, Department of Gynecologic Oncology, UZ Leuven, Campus Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. Electronic address: frederic.amant@kuleuven.be
Language :
English
Title :
Practice patterns, time trends and quality of care of uterine cancer in Belgium: An analysis of the EFFECT database.
ACF - Anticancer Fund [BE] Kom op Tegen Kanker [BE]
Funding text :
This study was funded by Kom op tegen Kanker, Brussels, Belgium (grant number: KotK/2018/11467/1 ). From 2012 to 2016, the EFFECT project was financially supported by the Anticancer Fund, Meise, Belgium (grant number: A11 ). Through the employment of Gauthier Bouche, the Anticancer Fund was involved in study design and the writing of this manuscript. Kom op tegen Kanker had no such involvement, nor any other involvement.The authors particularly thank all participating Belgian hospitals for voluntarily registering this valuable and comprehensive set of data in the project-specific EFFECT database. We also thank the Belgian Cancer Registry for collecting and maintaining the project-specific EFFECT database, as well as for linking it to both its own database and that of the InterMutualistic Agency. Finally, many thanks to both Kom op tegen Kanker for funding this study (grant number: KotK/2018/11467/1) and the Anticancer Fund for financially supporting the EFFECT project from 2012 to 2016 (grant number: A11).
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