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Eur J Surg Oncol. 2018 Feb;44(2):260-267. doi: 10.1016/j.ejso.2017.11.023. Epub 2017 Dec 13.

Factors contributing to variation in the use of multimodality treatment in patients with gastric cancer: A Dutch population based study.

Author information

1
Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: n.beck@lumc.nl.
2
Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
3
Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands; Mathematical Institute, Leiden University, Leiden, The Netherlands.
4
Department of Medical Oncology, The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
5
Department of Radiation Oncology, The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
6
Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
7
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
8
Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
9
Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
10
Department of Surgery, Jeroen Bosch Hospital's, Hertogenbosch, The Netherlands.
11
Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands; Medical Centre Haaglanden, The Hague, The Netherlands.
12
Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands.
13
Department of Pathology, VU Medical Centre, Amsterdam, The Netherlands.
14
Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
15
Department of Surgery, The Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
16
Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
17
Department of Surgery, Orbis Medical Centre, Sittard, The Netherlands.
18
Department of Surgery, Hospital Group Twente (ZGT), Almelo, The Netherlands.
19
Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
20
Netherlands Comprehensive Cancer Organization, Eindhoven, The Netherlands; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
21
Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
22
Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
23
Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
24
Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands.
25
Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
26
Department of Surgery, IJsselland Hospital, Capelle aan den IJsel, The Netherlands.
27
Netherlands Comprehensive Cancer Organization, Enschede, The Netherlands.

Abstract

BACKGROUND:

Substantial variation in the use of (neo) adjuvant treatment in patients with gastric cancer exists. The aim of this study was to identify underlying (organizational and process) factors associated with the use of perioperative therapy.

PATIENTS AND METHODS:

Patients with resectable gastric cancer who underwent surgery between 2012 and 2014 were selected from the Dutch Upper gastrointestinal Cancer Audit (DUCA). The proportion of perioperatively treated patients was defined per hospital. Five hospitals with the lowest percentage (LP group) and 5 hospitals with the highest percentage (HP group) of perioperative therapy were identified. In the selected hospitals additional information was obtained from patients' medical records using a structured list with predefined variables.

RESULTS:

In total, 429 patients (231 in LP group, 198 in HP group) from 9 different hospitals were included. Perioperative therapy was given in 16.0% of patients in the LP group compared to 40.4% in the HP group. In the LP group, patients were enrolled in a clinical trial less frequently (10.8% versus 26.8%, P<.001), and a higher percentage grade III-IV toxicity was observed during neoadjuvant treatment (25.7% versus 46.3%, P=.007). Multivariable analysis showed that, besides known casemix factors, consultation with ≥3 upper GI specialists prior to treatment decision was positively associated with initiating perioperative therapy (OR 2.08, 95% CI 1.19-3.66).

CONCLUSION:

Results of this study confirm considerable hospital variation in the use of perioperative therapy in patients with gastric cancer. Besides known casemix factors, use of perioperative therapy was associated with the level of involvement of multidisciplinary care.

KEYWORDS:

Combined modality therapy; Quality assurance; Stomach neoplasms

PMID:
29273212
DOI:
10.1016/j.ejso.2017.11.023
[Indexed for MEDLINE]

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