Hospital of diagnosis and probability to receive a curative treatment for oesophageal cancer.
BACKGROUND
Surgical treatment of oesophageal cancer in the Netherland is performed in high volume centres. However, the decision to refer patients for curative surgery is made in the referring hospital of diagnosis. The objective of this study was to determine the influence of hospital of diagnosis on the probability of receiving a curative treatment and survival.


METHODS
All patients with resectable oesophageal cancer (cT1-3, cN0-3, cM0-1A) diagnosed between 2003 and 2010 (n = 849) were selected from the population-based Eindhoven Cancer Registry, an area with ten non-academic hospitals. Multivariate logistic regression analysis was conducted to examine the independent influence of hospital of diagnosis on the probability to receive curative treatment. Furthermore, the effect of hospital of diagnosis on overall survival was examined using multivariate Cox regression analysis.


RESULTS
849 patients were included in the study. A difference in proportion of patients referred for surgery was observed ranging from 33% to 67% (p = 0.002) between hospitals of diagnosis. Multivariate logistic regression analysis confirmed the effect of hospital of diagnosis on the chance of undergo curative treatment (OR 0.1, 95% CI 0.1-0.4). Multivariate Cox regression analysis showed that hospital of diagnosis also had an effect on overall survival, up to hazard ratio (HR) 2.2 (95% CI 1.3-3.7).


CONCLUSIONS
There is a strong relation between hospital of diagnosis and the chance of referring patients with oesophageal cancer for a curative treatment as well as overall survival. Patients diagnosed with oesophageal cancer should be discussed within a regional multidisciplinary expert panel.
Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
M
M
Koëter
Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, The Netherlands.
L N
LN
van Steenbergen
Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, The Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
V E P P
VE
Lemmens
Department of Surgery, Catharina Hospital Eindhoven, The Netherlands; Department of Surgery, Maastricht University Medical Centre, The Netherlands.
H J T
HJ
Rutten
Department of Surgery, St. Elisabeth Hospital Tilburg, The Netherlands.
J A
JA
Roukema
Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
B P L
BP
Wijnhoven
Department of Surgery, Catharina Hospital Eindhoven, The Netherlands. Electronic address: grard.nieuwenhuijzen@catharinaziekenhuis.nl.
G A P
GA
Nieuwenhuijzen
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D011336:Probability; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data*
Curative surgery; Hospital of diagnosis; Oesophageal cancer; Survival