Geert Silversmit

Increased hospital case volume is associated with improved survival and quality of care for uterine corpus cancer in Belgium.

This study aimed to prospectively evaluate whether hospital case volume is positively associated with both the outcome and the quality of care of uterine corpus cancer in Belgium. This was a prospective, observational, registration-based, real-world database study. Hospital case volume was categorized according to the total number of patients treated on average per year: low (<10/y), medium (10-19/y), and high (≥20/y). Adjusting for patient case mix and intra-hospital correlations, logistic and Cox proportional hazards regression were used to test for associations between hospital case volume and a multi-disciplinary set of process and outcome indicators. Sub-group analyses by recurrence risk were performed for overall survival and disease-free survival. In total, 4178 patients diagnosed with a primary cancer of the uterine corpus between 2012 and 2016 in Belgium were included. Compared with patients treated in high-volume hospitals, patients treated in low-volume hospitals were more likely to die of any cause within 5 years after diagnosis (adjusted hazard ratio 1.37, p < .01), as were patients treated in medium-volume hospitals (adjusted hazard ratio 1.18, p < .05). Similar results were observed in the sub-group analyses, but only among patients with high-intermediate-risk and high-risk disease. In contrast, hazards for disease-free survival did not differ by hospital case volume, neither in the total study population nor in the sub-group analyses by recurrence risk. Furthermore, analysis of the process indicators showed that patients treated in low- and medium-volume hospitals were less likely to receive multiple guideline-recommended procedures compared with those treated in high-volume hospitals, including minimally invasive surgery, surgical lymph node staging, staging omentectomy, and adjuvant chemotherapy. On average, increased hospital case volume was positively associated with improved overall survival and quality of care, supporting centralization of uterine corpus cancer care into high-volume reference centers in Belgium.

Quality of surgery and treatment and its association with hospital volume: A population-based study in more than 5000 Belgian ovarian cancer patients

Different sets of quality indicators are used to identify areas for improvement in ovarian cancer care. This study reports transparently on how (surgical) indicators were measured and on the association between hospital volume and indicator results in Belgium, a country setting without any centralisation of ovarian cancer care. From the population-based Belgian Cancer Registry, patients with a borderline malignant or invasive epithelial ovarian tumour diagnosed between 2014 and 2018 were selected and linked to health insurance and vital status data (n = 5119). Thirteen quality indicators on diagnosis and treatment were assessed and the association with hospital volume was analysed using logistic regression adjusted for case-mix. The national results for most quality indicators on diagnosis and systemic therapy were around the predefined target value. Other indicators showed results below the benchmark: genetic testing, completeness of staging surgery, lymphadenectomy with at least 20 pelvic/para-aortic lymph nodes removed, and timely start of chemotherapy after surgery (within 42 days). Ovarian cancer care in Belgium is dispersed over 100 hospitals. Lower volume hospitals showed poorer indicator results compared to higher volume hospitals for lymphadenectomy, staging, timely start of chemotherapy and genetic testing. In addition, surgery for advanced stage tumours was performed less often in lower volume hospitals. The indicators that showed poorer results on a national level were also those with poorer results in lower-volume hospitals compared to higher-volume hospitals, consequently supporting centralisation. International benchmarking is hampered by different (surgical) definitions between countries and studies.

Association between hospital volume and outcomes in invasive ovarian cancer in Belgium: A population-based study

To study the association between hospital volume and outcomes in patients with invasive epithelial ovarian cancer (EOC). 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. 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. 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.