title: Treatment Patterns and Differences in Survival of Non-Small Cell Lung Cancer Patients Between Academic and Non-Academic Hospitals in the Netherlands.
abstract: The aims of this study are to analyze differences in survival between academic and non-academic hospitals and to provide insight into treatment patterns for non-small cell lung cancer (NSCLC). Results show the state of NSCLC survival and care in the Netherlands.
  
  
  
  The Netherlands Cancer Registry provided data on NSCLC survival for all Dutch hospitals. We used the Kaplan-Meier estimate to calculate median survival time by hospital type and a Cox proportional hazards model to estimate the relative risk of mortality (expressed as hazard ratios) for patients diagnosed in academic versus non-academic hospitals, with adjustment for age, gender, and tumor histology, and stratifying for disease stage. Data on treatment patterns in Dutch hospitals was obtained from 4 hospitals (2 academic, 2 non-academic). A random sample of patients diagnosed with NSCLC from January 2009 until January 2011 was identified through hospital databases. Data was obtained on patient characteristics, tumor characteristics, and treatments.
  
  
  
  The Cox proportional hazards model shows a significantly decreased hazard ratio of mortality for patients diagnosed in academic hospitals, as opposed to patients diagnosed in non-academic hospitals. This is specifically true for primary radiotherapy patients and patients who receive systemic treatment for non-metastasized NSCLC.
  
  
  
  Patients diagnosed in academic hospitals have better median overall survival than patients diagnosed in non-academic hospitals, especially for patients treated with radiotherapy, systemic treatment, or combinations. This difference may be caused by residual confounding since the estimates were not adjusted for performance status. A wide variety of surgical, radiotherapeutic, and systemic treatments is prescribed.
authors.affiliation: Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia. Electronic address: naomi.vanderlinden@chere.uts.edu.au.
authors.forename: Naomi
authors.initials: N
authors.lastname: van der Linden
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Mathilda L
authors.initials: ML
authors.lastname: Bongers
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Veerle M H
authors.initials: VMH
authors.lastname: Coupé
authors.affiliation: Pulmonology, VU University Medical Center, Amsterdam, the Netherlands; Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
authors.forename: Egbert F
authors.initials: EF
authors.lastname: Smit
authors.affiliation: Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Harry J M
authors.initials: HJM
authors.lastname: Groen
authors.affiliation: Department of Pulmonology, Medical Center Alkmaar, Alkmaar, the Netherlands.
authors.forename: Alle
authors.initials: A
authors.lastname: Welling
authors.affiliation: Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Franz M N H
authors.initials: FMNH
authors.lastname: Schramel
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University, Rotterdam, the Netherlands.
authors.forename: Carin A
authors.initials: CA
authors.lastname: Uyl-de Groot
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011013:Pneumonectomy / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012042:Registries; D015996:Survival Rate
keywords: Academic medical centers; Cancer registry; General hospitals; Mortality; Therapy