http://repub.eur.nl/res/aut/42645/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/35037/ 2012-01-01T00:00:00Z Surgical margin status after first breast-conserving surgery (BCS) is used as a quality indicator of breast cancer care in the Netherlands. The aim is to describe the variation in surgical margin status between hospitals. 7,345 patients with DCIS or invasive cancer (T1-2,N0-1,M0) diagnosed between July 1, 2008, and June 30, 2009, who underwent BCS as first surgery, were selected from the Netherlands Cancer Registry. Patients were treated in 96 hospitals. Maximum target values were 30% 'focally positive' or 'more than focally positive' for DCIS and 10% 'more than focally positive' for invasive carcinoma. Results per hospital are presented in funnel plots. For invasive carcinoma, multivariate logistic regression was used to adjust for case mix. Overall 28.5% (95% CI: 25.5-31.4%) of DCIS and 9.1% (95% CI: 8.4-9.8%) of invasive carcinoma had positive margins. Variation between hospitals was substantial. 6 and 10 hospitals, respectively, for DCIS and invasive cancer showed percentages above the upper limit of agreement. Case mix correction led to significant different conclusions for 5 hospitals. After case mix correction, 10 hospitals showed significant higher rates, while 7 hospitals showed significant lower rates. High rates were not related to breast cancer patient volume or type of hospital (teaching vs. non-teaching). Higher rates were related to hospitals where the policy is to aim for BCS instead of mastectomy. The overall percentage of positive margins in the Netherlands is within the predefined targets. The variation between hospitals is substantial but can be largely explained by coincidence. Case mix correction leads to relevant shifts. http://repub.eur.nl/res/pub/28992/ 2008-03-01T00:00:00Z Background: There is much debate on the necessity of regionalization of ovarian cancer care. We investigated the association between hospital type and survival of patients with ovarian cancer in The Netherlands. Methods: A retrospective, population-based cohort study was performed on all Dutch patients diagnosed with ovarian cancer from January 1, 1996, through December 31, 2003. We used data from the Netherlands Cancer Registry that were linked to mortality data from the Statistics Netherlands database to obtain the date and cause of death. Five-year relative survival ratios, defined as the ratio of the observed survival in the patient population to the expected survival of women in the general population with the same age, were determined for the total population and for groups stratified by tumor stage and/or hospital type. The association between hospital type and disease-specific survival was analyzed by use of multivariable Cox regression analyses. Results: We analyzed data from 8621 women with epithelial ovarian cancer, of whom 3482 (40%) were treated in general hospitals, 3510 (41%) were treated in semispecialized hospitals, and 1557 (18%) were treated in specialized hospitals. Five-year relative overall survival ratios of patients treated in general, semispecialized, and specialized hospitals were 38.0% (95% confidence interval [CI] = 36.0% to 39.9%), 39.4% (95% CI = 37.5% to 41.4%), and 40.3% (95% CI = 37.4% to 43.1%), respectively; median survival of patients aged 50-75 years was 36 months (interquartile range [IQR] = 13 to >54 months), 37 months (IQR = 14 to >54 months), and 38 months (IQR = 15 to >55 months), respectively. Age and cancer stage were associated with the relationship between hospital type and ovarian cancer-specific survival but histologic tumor type, grade, year of diagnosis, and socioeconomic status were not. Among patients with early-stage ovarian cancer, treatment in semispecialized and specialized hospitals was associated with lower risks of ovarian cancer-specific mortality than treatment in general hospitals. Among patients with stage I-IIA disease who were aged 50-75 years, risk of ovarian cancer-specific mortality was 30% and 42% lower after treatment in semispecialized and specialized hospitals, respectively, than in general hospitals (for semispecialized hospitals, hazard ratio [HR] = 0.70, 95% CI = 0.53 to 0.93; for specialized hospitals, HR = 0.58, 95% CI = 0.38 to 0.87). Among patients with advanced ovarian cancer, hospital type was not associated with survival. Conclusion: Hospital type was statistically significantly associated with survival among Dutch ovarian cancer patients with early-stage ovarian cancer: Patients who were treated in specialized and semispecialized hospitals survived longer than patients treated in general hospitals.