What Drives Centralisation in Cancer Care?

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 Apr 13

PMID 29649250

Citations 12

Authors

Melvin J Kilsdonk

Sabine Siesling

Boukje A C van Dijk

Michel W Wouters

Wim H van Harten

Affiliations

Soon will be listed here.

Abstract

Background: To improve quality of care, centralisation of cancer services in high-volume centres has been stimulated. Studies linking specialisation and high (surgical) volumes to better outcomes already appeared in the 1990's. However, actual centralisation was a difficult process in many countries. In this study, factors influencing the centralisation of cancer services in the Netherlands were determined.

Material And Methods: Centralisation patterns were studied for three types of cancer that are known to benefit from high surgical caseloads: oesophagus-, pancreas- and bladder cancer. The Netherlands Cancer Registry provided data on tumour and treatment characteristics from 2000-2013 for respectively 8037, 4747 and 6362 patients receiving surgery. By plotting timelines of centralisation of cancer surgery, relations with the appearance of (inter)national scientific evidence, actions of medical specialist societies, specific regulation and other important factors on the degree of centralisation were ascertained.

Results: For oesophagus and pancreas cancer, a gradual increase in centralisation of surgery is seen from 2005 and 2006 onwards following (inter)national scientific evidence. Centralisation steps for bladder cancer surgery can be seen in 2010 and 2013 anticipating on the publication of norms by the professional society. The most influential stimulus seems to have been regulations on minimum volumes.

Conclusion: Scientific evidence on the relationship between volume and outcome lead to the start of centralisation of surgical cancer care in the Netherlands. Once a body of evidence has been established on organisational change that influences professional practice, in addition some form of regulation is needed to ensure widespread implementation.

Citing Articles

Exploring the experiences of cancer patients: What drives them to seek treatment outside their residential area and what are the experiences resulting from that decision? A qualitative study.

Pyo J, Lee M, Lee H, Ock M PLoS One. 2025; 20(3):e0319650.

PMID: 40063639 PMC: 11892868. DOI: 10.1371/journal.pone.0319650.

The association between hospital volume and overall survival in adult AML patients treated with intensive chemotherapy.

Kaplan Z, van Leeuwen N, van Klaveren D, Eijkenaar F, Visser O, Posthuma E ESMO Open. 2025; 10(2):104152.

PMID: 39889323 PMC: 11833631. DOI: 10.1016/j.esmoop.2025.104152.

The anesthesia human resources crisis in Canada.

Leir S, Law T, Bould M Can J Anaesth. 2024; 71(12):1612-1626.

PMID: 39586924 DOI: 10.1007/s12630-024-02869-0.

An interrater reliability analysis of preoperative mortality risk calculators used for elective high-risk noncardiac surgical patients shows poor to moderate reliability.

Vernooij J, Roovers L, Zwan R, Preckel B, Kalkman C, Koning N BMC Anesthesiol. 2024; 24(1):392.

PMID: 39478449 PMC: 11523836. DOI: 10.1186/s12871-024-02771-8.

Comprehensive value implications of surgeon volume for lung cancer surgery: Use of an analytic framework within a regional health system.

Maxwell C, Bhat A, Falls S, Bigbee M, Yin Y, Chalikonda S JTCVS Open. 2024; 17:286-294.

PMID: 38420536 PMC: 10897681. DOI: 10.1016/j.xjon.2023.11.010.

References

Schrag D, Panageas K, Riedel E, Hsieh L, Bach P, Guillem J . Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection. J Surg Oncol. 2003; 83(2):68-78; discussion 78-9. DOI: 10.1002/jso.10244. View

de Vries R, Visser O, Nieuwenhuijzen J, Horenblas S . Outcome of treatment of bladder cancer: a comparison between low-volume hospitals and an oncology centre. World J Urol. 2010; 28(4):431-7. DOI: 10.1007/s00345-010-0512-z. View

Liu C, Chou Y, Teng C, Lin C, Lee Y, Hu Y . Association of surgeon volume and hospital volume with the outcome of patients receiving definitive surgery for colorectal cancer: A nationwide population-based study. Cancer. 2015; 121(16):2782-90. DOI: 10.1002/cncr.29356. View

Elting L, Pettaway C, Bekele B, Grossman H, Cooksley C, Avritscher E . Correlation between annual volume of cystectomy, professional staffing, and outcomes: a statewide, population-based study. Cancer. 2005; 104(5):975-84. DOI: 10.1002/cncr.21273. View

Ho V, van der Heiden-van der Loo M, Rutgers E, van Diest P, Hobbelink M, Tjan-Heijnen V . Implementation of sentinel node biopsy in breast cancer patients in the Netherlands. Eur J Cancer. 2008; 44(5):683-91. DOI: 10.1016/j.ejca.2008.01.027. View

Goossens-Laan C, Visser O, Wouters M, Jansen-Landheer M, Coebergh J, van de Velde C . Variations in treatment policies and outcome for bladder cancer in the Netherlands. Eur J Surg Oncol. 2010; 36 Suppl 1:S100-7. DOI: 10.1016/j.ejso.2010.06.003. View

Hollenbeck B, Daignault S, Dunn R, Gilbert S, Weizer A, Miller D . Getting under the hood of the volume-outcome relationship for radical cystectomy. J Urol. 2007; 177(6):2095-9. DOI: 10.1016/j.juro.2007.01.153. View

Killeen S, OSullivan M, Coffey J, Kirwan W, Redmond H . Provider volume and outcomes for oncological procedures. Br J Surg. 2005; 92(4):389-402. DOI: 10.1002/bjs.4954. View

Goossens-Laan C, Visser O, Hulshof M, Wouters M, Bosch J, Coebergh J . Survival after treatment for carcinoma invading bladder muscle: a Dutch population-based study on the impact of hospital volume. BJU Int. 2011; 110(2):226-32. DOI: 10.1111/j.1464-410X.2011.10694.x. View

10.

Gouma D, de Wit L, van Berge Henegouwen M, Van Gulik T, Obertop H . [Hospital experience and hospital mortality following partial pancreaticoduodenectomy in The Netherlands]. Ned Tijdschr Geneeskd. 1998; 141(36):1738-41. View

11.

Schouten L, Jager J, van den Brandt P . Quality of cancer registry data: a comparison of data provided by clinicians with those of registration personnel. Br J Cancer. 1993; 68(5):974-7. PMC: 1968711. DOI: 10.1038/bjc.1993.464. View

12.

Billingsley K, Morris A, Dominitz J, Matthews B, Dobie S, Barlow W . Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg. 2007; 142(1):23-31. DOI: 10.1001/archsurg.142.1.23. View

13.

Van Heek N, Kuhlmann K, Scholten R, de Castro S, Busch O, van Gulik T . Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005; 242(6):781-8, discussion 788-90. PMC: 1409869. DOI: 10.1097/01.sla.0000188462.00249.36. View

14.

Dudley R, Johansen K, Brand R, Rennie D, Milstein A . Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA. 2000; 283(9):1159-66. DOI: 10.1001/jama.283.9.1159. View

15.

Hillner B, Smith T, Desch C . Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000; 18(11):2327-40. DOI: 10.1200/JCO.2000.18.11.2327. View

16.

Luft H, Bunker J, Enthoven A . Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979; 301(25):1364-9. DOI: 10.1056/NEJM197912203012503. View

17.

Halm E, Lee C, Chassin M . Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med. 2002; 137(6):511-20. DOI: 10.7326/0003-4819-137-6-200209170-00012. View

18.

Birkmeyer J, Stukel T, Siewers A, Goodney P, Wennberg D, Lucas F . Surgeon volume and operative mortality in the United States. N Engl J Med. 2003; 349(22):2117-27. DOI: 10.1056/NEJMsa035205. View

19.

van Lanschot J, Hulscher J, Buskens C, Tilanus H, Ten Kate F, Obertop H . Hospital volume and hospital mortality for esophagectomy. Cancer. 2001; 91(8):1574-8. DOI: 10.1002/1097-0142(20010415)91:8<1574::aid-cncr1168>3.0.co;2-2. View

20.

Schouten L, Hoppener P, van den Brandt P, Knottnerus J, Jager J . Completeness of cancer registration in Limburg, The Netherlands. Int J Epidemiol. 1993; 22(3):369-76. DOI: 10.1093/ije/22.3.369. View