In its approach to continuous improvement of the quality of care for oncology patients, the KCE study published on Tuesday focuses precisely on ovarian cancer.
The Federal Center looked into the overall management of patients with ovarian cancer. The Center has identified 15 quality indicators from a list of 244 potential indicators. Each of them was measured nationally and by hospital.
A great dispersion of care
Navigating between the indicators reaching the objectives and those falling significantly below, the KCE provides an overview of the quality of care in Belgium.
First observation: the dispersion of care. Indeed, between 2014 and 2018, the 4,000 patients with invasive ovarian cancer were treated in 100 different hospitals in the country.
The dispersion is also found in the surgery figures: only five hospitals operated on more than twenty patients per year.
More patients, higher survival rate
The problem is that this dispersion of care is reflected in the survival rate. Indeed, again according to the KCE, the chances of survival for women affected by ovarian cancer strongly depend on the volume of care for this disease by the hospital. It should be noted that a threshold of 20 patients treated per year, per hospital and per surgeon, constitutes a minimum threshold. At 50 patients, the hospital is reaching an intermediate stage. At 100, its volume is “optimal“.
The chances of survival are on average significantly higher for patients with invasive cancer treated in hospitals with higher treatment/surgery volume.
“The chances of survival are on average significantly higher for patients with invasive cancer treated in hospitals with higher treatment/surgery volume”, notes the KCE. “Even after accounting for patient and tumor characteristics.”
According to the Federal Center study, the median survival of patients treated in a hospital treating at least ten patients per year is 4.2 years, against 1.7 in those treating less than three.
“So the difference is 2.5 years greater in favor of high-volume hospitals.”
Towards reference centers?
On the basis of this study, the KCE pleads in favor of concentrating the management of ovarian cancer, as is already the case in several countries.
“The wide dispersion of care and expertise in Belgian hospitals and the volume-outcome associations observed support the recommendation to concentrate the management of patients with ovarian cancer in reference centres.”
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