Variation in head and neck cancer care in the Netherlands: A retrospective cohort evaluation of incidence, treatment and outcome.
BACKGROUND
To explore variation in numbers and treatment between hospitals that treat head and neck cancer (HNC) in the Netherlands.


METHODS
Patient, tumor and treatment characteristics were collected from the Netherlands Cancer Registry, while histopathological features were obtained by linkage to the national pathology record register PALGA. Inter-hospital variation in volume, stage, treatment, pathologically confirmed loco-regional recurrence and overall survival rate was evaluated by tumor site.


RESULTS
In total, 2094 newly diagnosed patients were included, ranging from 65 to 417 patients in participating hospitals treating HNC in 2008. Oral cavity cancer was mainly treated by surgery only, ranging from 46 to 82% per hospital, while the proportion of surgery with (chemo)radiotherapy ranged from 18 to 40%. Increasing age, male sex, and high stage were associated with a higher hazard of dying. In oropharynx cancer, the use of (chemo)radiotherapy varied from 31 to 82% between hospitals. We found an indication that higher volume was associated with a lower overall hazard of dying for the total group, but not by subsite. Low numbers, e.g. for salivary gland, nasopharynx, nasal cavity and paranasal sinus, did not permit all desired analyses.


CONCLUSIONS
This study revealed significant interhospital variation in numbers and treatment of especially oropharyngeal and oral cavity cancer. This study is limited because we had to rely on data recorded in the past for a different purpose. To understand whether this variation is unwanted, future research should be based on prospectively collected data, including detailed information on recurrences, additional case-mix information and cause of death.
Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Head and Neck Surgery, Amsterdam, The Netherlands. Electronic address: m.d.ridder@nki.nl.
M
M
de Ridder
Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Head and Neck Surgery, Amsterdam, The Netherlands; Academic Medical Center, Department of Maxillo-facial Surgery, Amsterdam, The Netherlands.
A J M
AJM
Balm
Erasmus Medical Center, Department of Otorhinolaryngology, Rotterdam, The Netherlands.
R J
RJ
Baatenburg de Jong
University Medical Center Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands.
C H J
CHJ
Terhaard
Radboud University Medical Center, Department of Otorhinolaryngology, Nijmegen, The Netherlands.
R P
RP
Takes
Leiden University Medical Center, Department of Medical Oncology, Leiden, The Netherlands.
M
M
Slingerland
Maastricht University Medical Center, Department of Cranio-maxillofacial Surgery Maastricht, The Netherlands.
E
E
Dik
Medical Center Haaglanden, Department of Otorhinolaryngology, Den Haag, The Netherlands.
R J E
RJE
Sedee
Medical Center Leeuwarden, Department of Maxillo-facial Surgery, Leeuwarden, The Netherlands.
J G A M
JGAM
de Visscher
Rijnstate Hospital, Department of Otorhinolaryngology, Arnhem, The Netherlands.
H
H
Bouman
Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Pathology, Amsterdam, The Netherlands; The Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands (PALGA), The Netherlands; University Medical Center Utrecht, Department of Pathology, Utrecht, The Netherlands.
S M
SM
Willems
Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Surgical Oncology, Amsterdam, The Netherlands.
M W
MW
Wouters
Netherlands Cancer Institute - Antoni van Leeuwenhoek, Department of Head and Neck Surgery, Amsterdam, The Netherlands; Academic Medical Center, Department of Maxillo-facial Surgery, Amsterdam, The Netherlands.
L E
LE
Smeele
Comprehensive Cancer Organization The Netherlands (IKNL), Department of Research, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands.
B A C
BAC
van Dijk
D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
Epidemiology; Head and neck cancer; Outcome; Quality of care; Survival; Treatment