title: Improved outcomes due to changes in organization of care for patients with ovarian cancer in the Netherlands.
abstract: Objectives of this study were to evaluate the effect of changes in patterns of care, for example centralization and treatment sequence, on surgical outcome and survival in patients with epithelial ovarian cancer (EOC).
  
  
  
  Patients diagnosed with FIGO stage IIB-IV EOC (2004-2013) were selected from the Netherlands Cancer Registry. Primary outcomes were surgical outcome (extent of macroscopic residual tumor after surgery) and overall survival. Changes in treatment sequence (primary debulking surgery and adjuvant chemotherapy (PDS+ACT) or neo-adjuvant chemotherapy and interval debulking surgery (NACT+IDS)), hospital type and annual hospital volume were also evaluated.
  
  
  
  Patient and tumor characteristics of 7987 patients were retrieved. Most patients were diagnosed with stage III-IV EOC. The average annual case-load per hospital increased from 8 to 28. More patients received an optimal cytoreduction (tumor residue≤1cm) in 2013 (87%) compared to 2004 (55%, p<0.001). Complete cytoreduction (no macroscopic residual tumor), registered since 2010, increased from 42% to 52% (2010 and 2013, respectively, p<0.001). Optimal/complete cytoreduction was achieved in 85% in high volume (≥20 cytoreductive surgeries annually), 80% in medium (10-19 surgeries) and 71% in small hospitals (<10 surgeries, p<0.001). Within a selection of patients with advanced stage disease that underwent surgery the proportion of patients undergoing NACT+IDS increased from 28% (2004) to 71% (2013). Between 2004 and 2013 a 3% annual reduction in risk of death was observed (HR 0.97, p<0.001).
  
  
  
  Changes in pattern of care for patients with EOC in the Netherlands have led to improvement in surgical outcome and survival.
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands.
authors.forename: F A
authors.initials: FA
authors.lastname: Eggink
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands.
authors.forename: C H
authors.initials: CH
authors.lastname: Mom
authors.affiliation: Maastricht University Medical Center, Department of Obstetrics and Gynecology, Maastricht, The Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: R F
authors.initials: RF
authors.lastname: Kruitwagen
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, The Netherlands.
authors.forename: A K
authors.initials: AK
authors.lastname: Reyners
authors.affiliation: Antoni van Leeuwenhoek Hospital, Department of Gynecologic Oncology, Center for Gynecologic Oncology Amsterdam, Amsterdam, The Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: Van Driel
authors.affiliation: Radboud University Medical Center, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands.
authors.forename: L F
authors.initials: LF
authors.lastname: Massuger
authors.affiliation: University Medical Center Groningen, Department of UMC Staff, Groningen, The Netherlands.
authors.forename: G C
authors.initials: GC
authors.lastname: Niemeijer
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands.
authors.forename: A G
authors.initials: AG
authors.lastname: Van der Zee
authors.affiliation: Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Van der Aa
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, The Netherlands. Electronic address: h.w.nijman@umcg.nl.
authors.forename: H W
authors.initials: HW
authors.lastname: Nijman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008495:Medical Oncology / Q000458:organization & administration; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010818:Practice Patterns, Physicians'; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
keywords: Neo-adjuvant chemotherapy; Ovarian cancer; Pattern of care; Surgical outcome; Survival