title: The volume effect in paediatric oncology: a systematic review.
abstract: BACKGROUND
  For several adult cancer types, there is evidence that treatment in high volume hospitals, high case volume providers, or in specialised hospitals leads to a better outcome. The aim of this study is to give an overview of the existing evidence regarding the volume effect in paediatric oncology related to the quality of care or survival.
  
  
  METHODS
  An extensive search was carried out for studies on the effect of provider case volume on the quality of care or survival in childhood cancer. Information about study characteristics, comparisons, results, and quality assessment were abstracted.
  
  
  RESULTS
  In total, 14 studies were included in this systematic review. Studies with a low risk of bias provide evidence that treatment of children with brain tumours, acute lymphoblastic leukaemia, osteosarcoma, Ewing's sarcoma, or children receiving treatment with allogenic bone marrow transplantation in higher volume hospitals, specialised hospitals, or by high case volume providers, is related with a better outcome.
  
  
  CONCLUSIONS
  This systematic review provides support for the statement that higher volume hospitals, higher case volume providers, and specialised hospitals are related to the better outcome in paediatric oncology. No studies reported a negative effect of a higher volume.
authors: Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam. Electronic address: r.r.knops@amc.uva.nl.
authors: R R G
authors: RRG
authors: Knops
authors: Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam.
authors: E C
authors: EC
authors: van Dalen
authors: Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam.
authors: R L
authors: RL
authors: Mulder
authors: Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam.
authors: E
authors: E
authors: Leclercq
authors: Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam.
authors: S L
authors: SL
authors: Knijnenburg
authors: Dutch Childhood Oncology Group (Stichting Kinderoncologie Nederland), The Hague, The Netherlands.
authors: G J L
authors: GJL
authors: Kaspers
authors: Dutch Childhood Oncology Group (Stichting Kinderoncologie Nederland), The Hague, The Netherlands.
authors: R
authors: R
authors: Pieters
authors: Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam; Dutch Childhood Oncology Group (Stichting Kinderoncologie Nederland), The Hague, The Netherlands.
authors: H N
authors: HN
authors: Caron
authors: Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Centre, Amsterdam; Dutch Childhood Oncology Group (Stichting Kinderoncologie Nederland), The Hague, The Netherlands.
authors: L C M
authors: LCM
authors: Kremer
mesh_terms: D002173:Cancer Care Facilities / Q000592:standards*; D002648:Child; D006776:Hospitals, Pediatric; D006801:Humans; D008495:Medical Oncology; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D011787:Quality of Health Care; D016896:Treatment Outcome
keywords: childhood cancer; paediatric oncology; quality of care; volume