BACKGROUND: The presumed benefits of centralization and minimum case numbers often guide health-policy decisions, but these benefits remain inadequately documented, particularly in oncology. In this study, we aim to measure the effect of the type of treatment center and/or the number of patients treated in it on the outcome of patients with Hodgkin's lymphoma. METHODS:From 1988 to 2002, 8121 patients with newly diagnosed Hodgkin's lymphoma were treated in Germany in multicenter randomized and controlled trials (RCTs) of the German Hodgkin Study Group (GHSG). Center-related effects on progression-free survival (PFS) were assessed univariately with Kaplan-Meier plots and log-rank tests, as well as with a multivariate Cox regression model. RESULTS: The 500 participating centers in Germany included 52 university hospitals, 304 non-university hospitals, and 144 medical practices specializing in hematology and oncology. No significant differences in PFS were found between patients from centers with high or low case numbers (5-year-PFS: 78.7% and 78.6% for centers with fewer than 50 and more than 50 patients, respectively) or from different types of centers [5-year-PFS: university hospital, 77.7%; non-university hospital, 79.4%; practice, 79.8%]. Even after statistical controls for the effect of other known and unknown prognostic factors and validation in further datasets, no center effects were found. CONCLUSIONS: The type of center and the minimum number of patients treated in a center have no impact on the treatment outcome of patients with Hodgkin's lymphoma in Germany. In all GHSG centers, regardless of type, the quality standards for successful treatment are apparently met on all levels of patient care.
RCT Entities:
BACKGROUND: The presumed benefits of centralization and minimum case numbers often guide health-policy decisions, but these benefits remain inadequately documented, particularly in oncology. In this study, we aim to measure the effect of the type of treatment center and/or the number of patients treated in it on the outcome of patients with Hodgkin's lymphoma. METHODS: From 1988 to 2002, 8121 patients with newly diagnosed Hodgkin's lymphoma were treated in Germany in multicenter randomized and controlled trials (RCTs) of the German Hodgkin Study Group (GHSG). Center-related effects on progression-free survival (PFS) were assessed univariately with Kaplan-Meier plots and log-rank tests, as well as with a multivariate Cox regression model. RESULTS: The 500 participating centers in Germany included 52 university hospitals, 304 non-university hospitals, and 144 medical practices specializing in hematology and oncology. No significant differences in PFS were found between patients from centers with high or low case numbers (5-year-PFS: 78.7% and 78.6% for centers with fewer than 50 and more than 50 patients, respectively) or from different types of centers [5-year-PFS: university hospital, 77.7%; non-university hospital, 79.4%; practice, 79.8%]. Even after statistical controls for the effect of other known and unknown prognostic factors and validation in further datasets, no center effects were found. CONCLUSIONS: The type of center and the minimum number of patients treated in a center have no impact on the treatment outcome of patients with Hodgkin's lymphoma in Germany. In all GHSG centers, regardless of type, the quality standards for successful treatment are apparently met on all levels of patient care.
Authors: Markus Sieber; Hans Tesch; Beate Pfistner; Ulrich Rueffer; Bernd Lathan; Oana Brosteanu; Ursula Paulus; Tina Koch; Michael Pfreundschuh; Markus Loeffler; Andreas Engert; Andreas Josting; Jürgen Wolf; Dirk Hasenclever; Jeremy Franklin; Eckhart Duehmke; Axel Georgii; Klaus-Peter Schalk; Hartmut Kirchner; Gottfried Doelken; Reinhold Munker; Peter Koch; Richard Herrmann; Richard Greil; Anna Paola Anselmo; Volker Diehl Journal: J Clin Oncol Date: 2002-01-15 Impact factor: 44.544
Authors: F Frassoni; M Labopin; R Powles; J Y Mary; W Arcese; A Bacigalupo; D Bunjes; E Gluckman; T Ruutu; U W Schaefer; J Sierra; J P Vernant; R Willemze; T de Witte; N C Gorin Journal: Lancet Date: 2000-04-22 Impact factor: 79.321
Authors: E Dühmke; J Franklin; M Pfreundschuh; S Sehlen; N Willich; U Rühl; R P Müller; P Lukas; A Atzinger; U Paulus; B Lathan; U Rüffer; M Sieber; J Wolf; A Engert; A Georgii; S Staar; R Herrmann; M Beykirch; H Kirchner; A Emminger; R Greil; E Fritsch; P Koch; A Drochtert; O Brosteanu; D Hasenclever; M Loeffler; V Diehl Journal: J Clin Oncol Date: 2001-06-01 Impact factor: 44.544
Authors: Deborah Schrag; Craig Earle; Feng Xu; Katherine S Panageas; K Robin Yabroff; Robert E Bristow; Edward L Trimble; Joan L Warren Journal: J Natl Cancer Inst Date: 2006-02-01 Impact factor: 13.506
Authors: Hans Theodor Eich; Volker Diehl; Helen Görgen; Thomas Pabst; Jana Markova; Jürgen Debus; Anthony Ho; Bernd Dörken; Andreas Rank; Anca-Ligia Grosu; Thomas Wiegel; Johann Hinrich Karstens; Richard Greil; Normann Willich; Heinz Schmidberger; Hartmut Döhner; Peter Borchmann; Hans-Konrad Müller-Hermelink; Rolf-Peter Müller; Andreas Engert Journal: J Clin Oncol Date: 2010-08-16 Impact factor: 44.544
Authors: Volker Diehl; Jeremy Franklin; Michael Pfreundschuh; Bernd Lathan; Ursula Paulus; Dirk Hasenclever; Hans Tesch; Richard Herrmann; Bernd Dörken; Hans-Konrad Müller-Hermelink; Eckhardt Dühmke; Markus Loeffler Journal: N Engl J Med Date: 2003-06-12 Impact factor: 91.245
Authors: Catherine Ireland; Eric Wiedower; Muhammad Mirza; Melissa Crawley; Alexandria Tran; George Yaghmour; Mike G Martin Journal: World J Oncol Date: 2018-05-01
Authors: Maren Goeckenjan; A Freis; K Glaß; J Schaar; I Trinkaus; S Torka; P Wimberger; A Germeyer Journal: Arch Gynecol Obstet Date: 2020-05-06 Impact factor: 2.344