Artikel
Effectiveness of care in oncological centres – results from the WiZen study
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Autoren
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Veronika Bierbaum
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
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Olaf Schoffer
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
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Christoph Forkert
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
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Michael Gerken
- Tumorzentrum Regensburg – Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg, Deutschland
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Kees Kleihues van Tol
- Arbeitsgemeinschaft Deutscher Tumorzentren e.V., Berlin, Deutschland
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Patrik Dröge
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Deutschland
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Thomas Ruhnke
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Deutschland
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Andreas Klöss
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Deutschland
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Christian Günster
- Wissenschaftliches Institut der AOK (WIdO), Berlin, Deutschland
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Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg – Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg, Deutschland; Arbeitsgemeinschaft Deutscher Tumorzentren e.V., Berlin, Deutschland
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Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| Veröffentlicht: | 25. September 2020 |
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Gliederung
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Background and current state of (inter)national research: Cancer constitutes the second most frequent cause of death in Germany. Healthcare nowadays is facing the challenge of an increasing number of cancer patients, but also the implementation of quickly emerging innovative therapies. To maintain a high quality of treatment, the national cancer plan aims at a unified certification of cancer centres.
Questions and objectives: The effects of treatments in certified centres have not yet been investigated across large populations and different cancer entities. So far, studies on breast and colon cancer have shown associations with improved survival rates of patients treated in certified centers. The project „Wirksamkeit der Versorgung in onkologischen Zentren” (WiZen, “Effectiveness of care in oncological centres”) aims to close this gap.
Methods or hypothesis: In a retrospective comparative cohort study, incident cases of eight types of cancer diagnosed within 2009–2017 are analyzed based on nationwide health insurance data provided by WIdO (the AOK research institute) and data from regional clinical cancer registries.
Results: We present analyses based on secondary data from the statutory health insurance fund for colon, rectal and pancreatic cancer with 150,000 continuously insured patients for colon and rectal cancer (ICD-10: C18-C20) and 50,000 patients for pancreatic cancer (ICD-10: C25) and baseline statistics for breast cancer (ICD-10: C50). We discuss methods to identify incident cases in datasets with restricted observation period.
Discussion: Differences between the survival distribution, 1 and 5 year survival rates and 30-day mortality from initial treatment are computed for certified centers compared to non-certified clinics. Cox-regression with adjustment for confounding variables such as age, sex, comorbidities and secondary malignoma shows a 5–8% (colon and pancreatic cancer, respectively) survival advantage in certified centers compared to non-certified clinics. We discuss how the severity of the disease, which is not explicitly recorded in the health insurance data, can be approximated by therapeutical interventions and/or medication.
Practical Implications: The breadth of the database and complexity of analyses give reason to expect reliable new evidence for cancer care. First unadjusted results show differences with respect to the treatment in (non-)certified clinics.
