The more patients with a particular cancer are treated in a hospital, the better the team of doctors and nurses becomes, and the greater the chance that the patient will survive the disease. That was the reason for former Minister of Health Maggie De Block (Open Vld) to significantly reduce the number of hospitals that operate on patients with pancreatic cancer. Since July 2019, complex operations have only been reimbursed in hospitals that can prove that they perform at least twenty such procedures annually.
The UZ Brussels was left out at the time and did not receive recognition for operating on pancreatic cancer. De Tijd has now discovered that the hospital nevertheless continued to perform the operations.
1 As a patient with pancreatic cancer, are you worse off at UZ Brussels than elsewhere?
There is no question that lives are saved when cancer care is centralized in a smaller number of hospitals. Since July 2019, 15 Belgian hospitals have been recognized to perform complex pancreatic surgery. This includes the university hospitals of Leuven, Ghent and Antwerp. Non-academic hospitals such as ASZ Aalst and Jessa Hospital also have such recognition.
In the period 2015 to 2018, before the centralization of cancer care, 4.3 percent of patients with pancreatic cancer died within 30 days after surgery, according to the Cancer Register. This fell to 2.6 percent between mid-2019 and mid-2022. The Cancer Register speaks of a significant decrease.
The UZ Brussels does not want to say how high its mortality rate after pancreatic surgery is, but the spokeswoman reports to De Standaard that the hospital is “around the national average”. CEO Mark Noppen says in De Tijd that they have performed about a hundred pancreas operations over the years, “more than some recognized centers”. “Today we also meet all other quality criteria,” says Noppen.
Liesbet Van Eycken, director of the Cancer Register, points out that it is about more than just survival figures. “The accredited centers work closely together to increase not only the chance of survival, but also the quality of life of patients. For example, they look at their guidelines together: are major interventions handled correctly, are certain aggressive treatments really always necessary? UZ Brussels is now no longer part of that intense collaboration around the quality of care. Patients need to know that.”
2 Are the pancreas operations at the UZ Brussels illegal?
In De Tijd, the cabinet of current Minister of Health Frank Vandenbroucke (Vooruit) says that hospitals that are not recognized for the treatment of pancreatic cancer are no longer allowed to perform the procedures. Vandenbroucke is now investigating the situation. “We don’t want to anticipate the conclusions.”
Today, the recognition of centers that are allowed to perform complex pancreatic surgery is linked to reimbursement. The health insurance (Riziv) does not reimburse four operations on the pancreas if they are performed in a hospital that is not recognized. At UZ Brussels, the hospital and/or doctors cover the costs.
It seems surprising that hospitals or doctors would be willing to pay for operations out of their own pocket if they are left out of the recognition process. Hospitals miss no opportunity to address their poor financial situation and doctors are also not prepared to compromise financially.
What Vandenbroucke will do with the UZ Brussels case is important for other forms of cancer. Last year, Vandenbroucke decided to stop reimbursement for breast cancer treatment outside recognized breast clinics. He was responding to a study showing that Belgian patients treated outside a recognized breast cancer clinic have a 30 percent greater risk of dying within five years.
3 If they don’t get money for it, what drives hospitals to treat cancer patients without recognition?
It can be a loss for hospitals if a certain type of cancer is suddenly no longer allowed to be treated. Specialized doctors then threaten to move to hospitals where they can perform all operations and maintain their skills.
It seems that UZ Brussels is in exactly this situation. In De Tijd, CEO Noppen points out that his hospital has “top surgeons” and an “excellent oncological and radiotherapy team”.
The hospital submitted a file last year to be recognized as a center where complex pancreatic surgery can be performed. “We are now waiting for feedback from the government,” the spokeswoman said.
