Hospital of Diagnosis Influences the Probability of Receiving Curative Treatment for Esophageal Cancer.
The aim of this article was to study the influence of hospital of diagnosis on the probability of receiving curative treatment and its impact on survival among patients with esophageal cancer (EC).



Although EC surgery is centralized in the Netherlands, the disease is often diagnosed in hospitals that do not perform this procedure.



Patients with potentially curable esophageal or gastroesophageal junction tumors diagnosed between 2005 and 2013 who were potentially curable (cT1-3,X, any N, M0,X) were selected from the Netherlands Cancer Registry. Multilevel logistic regression was performed to examine the probability to undergo curative treatment (resection with or without neoadjuvant treatment, definitive chemoradiotherapy, or local tumor excision) according to hospital of diagnosis. Effects of variation in probability of undergoing curative treatment among these hospitals on survival were investigated by Cox regression.



All 13,017 patients with potentially curable EC, diagnosed in 91 hospitals, were included. The proportion of patients receiving curative treatment ranged from 37% to 83% and from 45% to 86% in the periods 2005-2009 and 2010-2013, respectively, depending on hospital of diagnosis. After adjustment for patient- and hospital-related characteristics these proportions ranged from 41% to 77% and from 50% to 82%, respectively (both P < 0.001). Multivariable survival analyses showed that patients diagnosed in hospitals with a low probability of undergoing curative treatment had a worse overall survival (hazard ratio = 1.13, 95% confidence interval 1.06-1.20; hazard ratio = 1.15, 95% confidence interval 1.07-1.24).



The variation in probability of undergoing potentially curative treatment for EC between hospitals of diagnosis and its impact on survival indicates that treatment decision making in EC may be improved.
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Margreet
M
van Putten
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Marijn
M
Koëter
Department of Medical Oncology, Academic Medical Center of Amsterdam, Amsterdam, The Netherlands.
Hanneke W M
HWM
van Laarhoven
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.|Department of Public Health, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.
Valery E P P
VEPP
Lemmens
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Peter D
PD
Siersema
Department of Radiotherapy, Academic Medical Center of Amsterdam, Amsterdam, The Netherlands.
Maarten C C M
MCCM
Hulshof
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Rob H A
RHA
Verhoeven
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Grard A P
GAP
Nieuwenhuijzen
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; 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; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011336:Probability; D016016:Proportional Hazards Models; D012042:Registries; D016896:Treatment Outcome