Variation in head and neck cancer care in the Netherlands: A retrospective cohort evaluation of incidence, treatment and outcome
Introduction
Head and neck cancer (HNC) consists of a heterogeneous group of cancers. The individual types are characterized by their low incidences, but as group they take the 7th and 9th place in men and women, respectively, in the Netherlands.1
Because of the many vital functions in the head and neck, the delicate balance between optimal oncological and functional outcome characterizes treatment choices for of HNC. Centralization of care was shown to improve outcome in HNC and other high-complex types of cancer treatment.2, 3, 4, 5, 6, 7, 8, 9
Since the foundation of the Dutch Head and Neck Society (DHNS) in 1984, over 90% of HNC patients are treated in specialized head and neck cancer centers (HNCC) in the Netherlands.10 Several HNCCs collaborate with regional hospitals (Preferred Partner clinics (PPC)). In the Netherlands, possibly related to this centralization, survival rates are good for HNC compared to other European countries.11, 12
Despite the presence of national guidelines, differences in treatment patterns have been described for the American13 and British14 setting. To discover the extent of variation between hospitals treating HNC in the Netherlands, we studied variation in patient and tumor characteristics, type of treatment, volume, recurrences and overall survival for HNC patients within the participating hospitals.
Section snippets
Data sources
All patients diagnosed with primary invasive HNC in 2008 identified in the Netherlands Cancer Registry (NCR) and known in one of the participating hospitals were included. Patients with carcinoma in situ, skin cancer, sarcomas or hematological malignancies of the head and neck area were excluded.
The NCR is population-based and cancer cases are identified from pathology records received from the nationwide pathology network PALGA, as well as from the hospital discharge registry. The completeness
Results
In total 2094 patients, were included in this study. The number of newly diagnosed patients in 2008 ranged from 129 to 417 in HNCC and from 65 to 86 in PPC. There was variation in site distribution and in sex between hospitals (Table 1). In all subsites, men were more affected than women.
Discussion
This study describes HNC patients' characteristics and outcome from 7 HNCCs and 3 PPCs in 2008 in the Netherlands. The number of HNC patients equaled 2094 and ranged from 65 to 417 per center.
Variation in treatment is one of the primary findings in this study and has been described in the literature before. In previous American13 and British14 studies, differences in treatment regimens were described, despite the presence of national guidelines, mainly due to health care organization. However,
Funding
This study was financially supported by the Dutch Cancer Society (grant number: 2013-6480).
Role of funding source
Personnel costs, data acquisition and quality control costs.
The funding source was not involved in data interpretation or manuscript preparation
Acknowledgements
This study was supported by the Dutch Head and Neck Cooperative Group (study number: NWHHT 2014-02). The authors thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the Netherlands Cancer Registry (NCR) as well as the participating Head and Neck Cancer Centers (HNCC) and their Preferred Partner Clinics (PPC) for approval to use these data.
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Improved survival in patients with head and neck cancer treated in higher volume centres: A population-based study in Belgium
2020, European Journal of CancerCitation Excerpt :This study further reveals that the 5-year observed survival for patients with HNSCC is just below 50%. For all four anatomic sites, the 5-year observed survival probabilities in this cohort were lower than the ones obtained in a Dutch cohort [30], whereas the relative survival probabilities compared favourably with another Dutch study [40]. Yet, comparing observed and relative survival probabilities of head and neck cancer between countries should be done with caution, as in some publications the study cohort also includes cancers of other anatomic locations (e.g. the lip with a known better prognosis) and/or cancers other than SCC [30,41].
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Dutch Head and Neck Research Group includes representatives from all head and neck cancer centers in the Netherlands.