Variation in treatment and outcome of patients with rectal cancer by region, hospital type and volume in the Netherlands

Patterns of Colorectal Cancer Care in Europe, Australia, and New Zealand

“…However, other studies indicated mixed findings for rates of surgical treatment by patient age depending upon type of surgery, time period, and disease severity (26,31,79). Studies also reported mixed findings regarding the association of female gender with the likelihood of receiving surgical treatment (31,38,55,84).…”

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

“…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.…”

“…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.…”

“…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.…”

“…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).…”