M van de Ven1, V P Retèl2, H Koffijberg3, W H van Harten4, M J IJzerman5. 1. Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Hallenweg 17, 7522 NH, Enschede, the Netherlands. 2. Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Hallenweg 17, 7522 NH, Enschede, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands. 3. Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Hallenweg 17, 7522 NH, Enschede, the Netherlands. Electronic address: h.koffijberg@utwente.nl. 4. Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Hallenweg 17, 7522 NH, Enschede, the Netherlands; Rijnstate General Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands. 5. Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Hallenweg 17, 7522 NH, Enschede, the Netherlands; Cancer Health Services Research Unit, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 235 Bouverie St, Carlton, VIC, 3053, Australia; Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia.
Abstract
OBJECTIVES: Increased emphasis on molecular diagnostics can lead to increased variation in time to treatment (TTT) for patients with stage III and IV non-small cell lung cancer. This article presents the variation in TTT for advanced NSCLC patients observed in Dutch hospitals before the widespread use of immunotherapy. The aim of this article was to explore the variation in TTT between patients, as well as between hospitals. MATERIAL AND METHODS: Based on the Netherlands Cancer Registry, we used patient-level data (n = 4096) from all 78 hospitals that diagnosed stage III or IV NSCLC in the Netherlands in 2016. To investigate how patient characteristics and hospital-level effects are associated with TTT (from diagnosis until start treatment), we interpreted regression model results for five common patient profiles to analyze the influence of age, gender, tumor stage, performance status, histology, and referral status as well as hospital-level characteristics on the TTT. RESULTS AND CONCLUSIONS: TTT varies substantially between and within hospitals. The median TTT was 28 days with an inter-quartile range of 22 days. The hospital-level median TTT ranges from 17 to 68 days. TTT correlates significantly with tumor stage, performance status, and histology. The hospital-level effect, unrelated to hospital volume and type, affected TTT by several weeks at most. For most patients, TTT is within range as recommended in current guidelines. Variation in TTT seems higher for patients receiving either radiotherapy or targeted therapy, or for patients referred to another hospital and we hypothesize this is related to the complexity of the diagnostic pathway. With further advances in molecular diagnostics and precision oncology we expect variation in TTT to increase and this needs to be considered in designing optimal cancer care delivery.
OBJECTIVES: Increased emphasis on molecular diagnostics can lead to increased variation in time to treatment (TTT) for patients with stage III and IV non-small cell lung cancer. This article presents the variation in TTT for advanced NSCLCpatients observed in Dutch hospitals before the widespread use of immunotherapy. The aim of this article was to explore the variation in TTT between patients, as well as between hospitals. MATERIAL AND METHODS: Based on the Netherlands Cancer Registry, we used patient-level data (n = 4096) from all 78 hospitals that diagnosed stage III or IV NSCLC in the Netherlands in 2016. To investigate how patient characteristics and hospital-level effects are associated with TTT (from diagnosis until start treatment), we interpreted regression model results for five common patient profiles to analyze the influence of age, gender, tumor stage, performance status, histology, and referral status as well as hospital-level characteristics on the TTT. RESULTS AND CONCLUSIONS: TTT varies substantially between and within hospitals. The median TTT was 28 days with an inter-quartile range of 22 days. The hospital-level median TTT ranges from 17 to 68 days. TTT correlates significantly with tumor stage, performance status, and histology. The hospital-level effect, unrelated to hospital volume and type, affected TTT by several weeks at most. For most patients, TTT is within range as recommended in current guidelines. Variation in TTT seems higher for patients receiving either radiotherapy or targeted therapy, or for patients referred to another hospital and we hypothesize this is related to the complexity of the diagnostic pathway. With further advances in molecular diagnostics and precision oncology we expect variation in TTT to increase and this needs to be considered in designing optimal cancer care delivery.
Authors: Christine M Cramer-van der Welle; Lotte van Loenhout; Ben Eem van den Borne; Franz Mnh Schramel; Lea M Dijksman Journal: BMJ Open Date: 2021-01-15 Impact factor: 2.692
Authors: Michiel van de Ven; Maarten IJzerman; Valesca Retèl; Wim van Harten; Hendrik Koffijberg Journal: BMC Med Res Methodol Date: 2022-03-27 Impact factor: 4.615