G Gatta1, L Botta2, H Comber3, N Dimitrova4, M K Leinonen5, K Pritchard-Jones6, S Siesling7, A Trama2, L Van Eycken8, J M van der Zwan7, O Visser7, T Zagar9, R Capocaccia10. 1. Evaluative Epidemiology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: gemma.gatta@istitutotumori.mi.it. 2. Evaluative Epidemiology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy. 3. National Cancer Registry Ireland, Cork, Ireland. 4. Bulgarian National Cancer Registry, Sofia, Bulgaria. 5. Cancer Society of Finland, Finnish Cancer Registry, Helsinki, Finland. 6. Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, UK. 7. Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands. 8. Belgian Cancer Registry, Brussels, Belgium. 9. Institute of Oncology Ljubljana, Epidemiology and Cancer Registry, Ljubljana, Slovenia. 10. Editorial board "Epidemiologia e Prevenzione".
Abstract
BACKGROUND: It is generally agreed to centralise treatment of childhood cancers (CCs). We analysed (1) the degree of centralisation of CCs in European countries and 2) the relations between centralisation and survival. PATIENTS AND METHODS: The analysis comprised 4415 CCs, diagnosed between 2000 and 2007 and followed up to the end of 2013, from Belgium, Bulgaria, Finland, Ireland, the Netherlands and Slovenia. All these countries had national population-based cancer registries and were able to provide information on diagnosis, treatment, treatment hospitals, and survival. Each case was then classified according to whether the patient was treated in a high- or a low-volume hospital among those providing CC treatment. A Cox proportional hazard model was used to calculate the relation between volume category and five-year survival, adjusting by age, sex and diagnostic group. RESULTS: The number of hospitals providing treatment for CCs ranged from six (Slovenia) to slightly more than 40 (the Netherlands and Belgium). We identified a single higher volume hospital in Ireland and in Slovenia, treating 80% and 97% of cases, respectively, and three to five major hospitals in the other countries, treating between 65% and 93% of cases. Outcome was significantly better when primary treatment was given in high-volume hospitals compared to low-volume hospitals for central nervous system tumours (relative risk [RR] = 0.71), haematologic tumours (RR = 0.74) and for all CC combined (RR = 0.83). CONCLUSION: Treatment centralisation is associated with survival benefits and should be further strengthened in these countries. New plans for centralisation should include ongoing evaluation.
BACKGROUND: It is generally agreed to centralise treatment of childhood cancers (CCs). We analysed (1) the degree of centralisation of CCs in European countries and 2) the relations between centralisation and survival. PATIENTS AND METHODS: The analysis comprised 4415 CCs, diagnosed between 2000 and 2007 and followed up to the end of 2013, from Belgium, Bulgaria, Finland, Ireland, the Netherlands and Slovenia. All these countries had national population-based cancer registries and were able to provide information on diagnosis, treatment, treatment hospitals, and survival. Each case was then classified according to whether the patient was treated in a high- or a low-volume hospital among those providing CC treatment. A Cox proportional hazard model was used to calculate the relation between volume category and five-year survival, adjusting by age, sex and diagnostic group. RESULTS: The number of hospitals providing treatment for CCs ranged from six (Slovenia) to slightly more than 40 (the Netherlands and Belgium). We identified a single higher volume hospital in Ireland and in Slovenia, treating 80% and 97% of cases, respectively, and three to five major hospitals in the other countries, treating between 65% and 93% of cases. Outcome was significantly better when primary treatment was given in high-volume hospitals compared to low-volume hospitals for central nervous system tumours (relative risk [RR] = 0.71), haematologic tumours (RR = 0.74) and for all CC combined (RR = 0.83). CONCLUSION: Treatment centralisation is associated with survival benefits and should be further strengthened in these countries. New plans for centralisation should include ongoing evaluation.
Authors: Jean de Ville de Goyet; Toni Illhardt; Christophe Chardot; Peace N Dike; Ulrich Baumann; Katherine Brandt; Barbara E Wildhaber; Mikko Pakarinen; Fabrizio di Francesco; Ekkehard Sturm; Marianna Cornet; Caroline Lemoine; Eva Doreen Pfister; Ana M Calinescu; Maria Hukkinen; Sanjiv Harpavat; Fabio Tuzzolino; Riccardo Superina Journal: J Clin Med Date: 2022-04-12 Impact factor: 4.964
Authors: Daniel Berney; Anju Sahdev; Jonathan Shamash; Wendy Ansell; Constantine Alifrangis; Benjamin Thomas; Peter Wilson; Sara Stoneham; Danish Mazhar; Anne Warren; Tristan Barrett; Susanna Alexander; Sarah Rudman; Michelle Lockley Journal: Br J Cancer Date: 2020-09-29 Impact factor: 7.640