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Great differences in cancer treatment in Dutch hospitals31 January 2014, by Alexandra Gowling
A study by Dutch cancer society KWF has revealed there are great differences in the quality of cancer treatment among hospitals in the Netherlands.
They found that oncologists may only perform certain operations a few times a year and that some do not comply with guidelines. This results in uneven treatment outcomes, with patients in one hospital having better results than those in another.
The study comes directly after another investigation showed that there were also great differences in patient treatment for hernias.
Standard of care in Dutch hospitals
Co-author of the report and surgical oncologist Michel Wouters stressed that while the quality of patient care in the Netherlands is high, there is "a considerable chance that a patient may have a greater chance of survival at one hospital than at another."
The differences are particularly great in prostate cancer, which is the main form of cancer in men with almost 12.000 new cases each year.
Only one third of prostate cancer patients with an aggressive form of the disease get hormone therapy in addition to radiation, although the guidelines prescribe hormone therapy as patients then live longer.
The report also found that those hospitals which purchased the expensive Da Vinci surgical robot for prostate removal were more often removing the whole prostate than those hospitals in which surgeons did the operation.
The report is critical of the "rampant introduction" of the robots, as it is unknown whether full removal of the prostate has better results and operations with the robot are 2.000 to 4.500 euros more expensive than normal ones.
Reductions in the number of surgeries
Since the introduction of minimum standards in Dutch hospitals, certain cancer surgeries are no longer performed in many hospitals.
Now, almost half of all hospitals have stopped treating gastric cancer and 40 per cent have stopped doing pancreatic cancer operations.
Also, hospitals now have limits on the number of cancer surgeries they can perform in a year, as cancer treatment becomes more standardised.
For example, operations for stomach, pancreatic and cervical cancer are now limited to 20 times per year per hospital, while bladder cancer operations are limited to 10.
Research has shown, however, that the survival of cancer patients often rises sharply when surgeons perform operations more often and thus hone their skills.
Wouters said that the lower limit on surgery numbers will need to rise for many cancers, especially prostate, testicular, sarcoma and thyroid surgery.
"It is important now that standards are set for other parts of treatment. There must be standards in chemotherapy for testicular cancer. Some oncologists consider five patients a year sufficient, but that number really has to go up."
Setting up national cancer registers
Some cancer specialists have set up national registers for a particular cancer, a move which saw a 20 per cent decrease in mortality after surgery for bowel cancer.
But some cancer specialist are too slow in setting up theirs, says Wouters. "Until five years ago, surgeons never saw that their results were worse than their peers.
"Now they can for colon, breast and lung cancer. Surgeons can see almost immediately that the number of complications among their patients is high, so they then think: what am I doing wrong? That has a very rapid effect on their actions. This should be done with all forms of cancer."
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