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Völkel V, Gerken M, Kleihues-van Tol K, Schoffer O, Bierbaum V, Bobeth C, Roessler M, Reissfelder C, Fürst A, Benz S, Rau BM, Piso P, Distler M, Günster C, Hansinger J, Schmitt J, Klinkhammer-Schalke M. Treatment of Colorectal Cancer in Certified Centers: Results of a Large German Registry Study Focusing on Long-Term Survival. Cancers (Basel) 2023; 15:4568. [PMID: 37760537 PMCID: PMC10526771 DOI: 10.3390/cancers15184568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The WiZen study is the largest study so far to analyze the effect of the certification of designated cancer centers on survival in Germany. This certification program is provided by the German Cancer Society (GCS) and represents one of the largest oncologic certification programs worldwide. Currently, about 50% of colorectal cancer patients in Germany are treated in certified centers. (2) Methods: All analyses are based on population-based clinical cancer registry data of 47.440 colorectal cancer (ICD-10-GM C18/C20) patients treated between 2009 and 2017. The primary outcome was 5-year overall survival (OAS) after treatment at certified cancer centers compared to treatment at other hospitals; the secondary endpoint was recurrence-free survival. Statistical methods included Kaplan-Meier analysis and multivariable Cox regression. (3) Results: Treatment at certified hospitals was associated with significant advantages concerning 5-year overall survival (HR 0.92, 95% CI 0.89, 0.96, adjusted for a broad range of confounders) for colon cancer patients. Concentrating on UICC stage I-III patients, for whom curative treatment is possible, the survival benefit was even larger (colon cancer: HR 0.89, 95% CI 0.84, 0.94; rectum cancer: HR 0.91, 95% CI 0.84, 0.97). (4) Conclusions: These results encourage future efforts for further implementation of the certification program. Patients with colorectal cancer should preferably be directed to certified centers.
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Affiliation(s)
- Vinzenz Völkel
- Tumor Center Regensburg, Center of Quality Management and Health Services Research, University of Regensburg, 93053 Regensburg, Germany (M.K.-S.)
| | - Michael Gerken
- Tumor Center Regensburg, Center of Quality Management and Health Services Research, University of Regensburg, 93053 Regensburg, Germany (M.K.-S.)
- Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, 93053 Regensburg, Germany
| | | | - Olaf Schoffer
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany; (O.S.); (J.S.)
| | - Veronika Bierbaum
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany; (O.S.); (J.S.)
| | - Christoph Bobeth
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany; (O.S.); (J.S.)
| | - Martin Roessler
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany; (O.S.); (J.S.)
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Alois Fürst
- Klinik für Allgemein-, Viszeral-, Thoraxchirurgie und Adipositasmedizin, Caritas Krankenhaus St., 93053 Regensburg, Germany
| | - Stefan Benz
- Arbeitsgemeinschaft Deutscher Tumorzentren e.V. (ADT), 14057 Berlin, Germany
- Klinik für Allgemein-, Viszeral-, Thorax- und Kinderchirurgie, 71032 Böblingen, Germany
| | - Bettina M. Rau
- Department of General, Visceral and Thoracic Surgery, Hospital of Neumarkt, 92318 Neumarkt in der Oberpfalz, Germany
| | - Pompiliu Piso
- Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus der Barmherzigen Brüder, 93049 Regensburg, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany
| | | | - Judith Hansinger
- Tumor Center Regensburg, Center of Quality Management and Health Services Research, University of Regensburg, 93053 Regensburg, Germany (M.K.-S.)
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, Dresden University of Technology (TU Dresden), 01307 Dresden, Germany; (O.S.); (J.S.)
| | - Monika Klinkhammer-Schalke
- Tumor Center Regensburg, Center of Quality Management and Health Services Research, University of Regensburg, 93053 Regensburg, Germany (M.K.-S.)
- Arbeitsgemeinschaft Deutscher Tumorzentren e.V. (ADT), 14057 Berlin, Germany
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2
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Wolff I, Burchardt M, Peter J, Thomas C, Sikic D, Fiebig C, Promnitz S, Hoschke B, Burger M, Schnabel MJ, Gilfrich C, Löbig N, Harke NN, Distler FA, May M. Patient's Desire and Real Availability Concerning Supportive Measures Accompanying Radical Prostatectomy: Differences between Certified Prostate Cancer Centers and Non-Certified Centers Based on Patient-Reported Outcomes within the Cross-Sectional Study Improve. Cancers (Basel) 2023; 15:2830. [PMID: 37345167 DOI: 10.3390/cancers15102830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
Certification as a prostate cancer center requires the offer of several supportive measures to patients undergoing radical prostatectomy (RP). However, it remains unclear how patients estimate the relevance of these measures and whether the availability of these measures differs between certified prostate cancer centers (CERTs) and non-certified centers (NCERTs). In 20 German urologic centers, a survey comprising questions on the relevance of 15 supportive measures was sent to 1000 patients at a median of 15 months after RP. Additionally, patients were asked to rate the availability of these measures using a four-item Likert scale. The aim of this study was to compare these ratings between CERTs and NCERTs. The response rate was 75.0%. In total, 480 patients underwent surgery in CERTs, and 270 in NCERTs. Patients rated 6/15 supportive measures as very relevant: preoperative medical counselling concerning treatment options, a preoperative briefing answering last questions, preoperative pelvic floor exercises (PFEs), postoperative PFEs, postoperative social support, and postoperative rehabilitation addressing physical fitness recovery. These ratings showed no significant difference between CERTs and NCERTs (p = 0.133-0.676). In addition, 4/9 of the remaining criteria were rated as more detailed by patients in CERTs. IMPROVE represents the first study worldwide to evaluate a patient-reported assessment of the supportive measures accompanying RP. Pertinent offers vary marginally between CERTs and NCERTs.
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Affiliation(s)
- Ingmar Wolff
- Department of Urology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Martin Burchardt
- Department of Urology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Julia Peter
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Christian Fiebig
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Sören Promnitz
- Department of Urology, Klinikum Frankfurt (Oder), 15236 Frankfort (Oder), Germany
| | - Bernd Hoschke
- Department of Urology and Pediatric Urology, Carl-Thiem-Klinikum Cottbus, 03048 Cottbus, Germany
| | - Maximilian Burger
- Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany
| | - Marco J Schnabel
- Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany
| | - Christian Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
| | - Niklas Löbig
- Department of Urology, University Hospital Ulm, 89081 Ulm, Germany
| | - Nina N Harke
- Department of Urology and Urologic Oncology, Hanover Medical School, 30625 Hanover, Germany
| | - Florian A Distler
- Department of Urology, Paracelsus Medical University Nuremberg, 90419 Nuremberg, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
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Koh HJW, Whitelock-Wainwright E, Gasevic D, Rankin D, Romero L, Frydenberg M, Evans S, Talic S. Quality Indicators in the Clinical Specialty of Urology: A Systematic Review. Eur Urol Focus 2022:S2405-4569(22)00288-7. [PMID: 36577611 DOI: 10.1016/j.euf.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/11/2022] [Accepted: 12/06/2022] [Indexed: 12/27/2022]
Abstract
CONTEXT In health care, monitoring of quality indicators (QIs) in general urology remains underdeveloped in comparison to other clinical specialties. OBJECTIVE To identify, synthesise, and appraise QIs that monitor in-hospital care for urology patients. EVIDENCE ACQUISITION This systematic review included peer-reviewed articles identified via Embase, MEDLINE, Web of Science, CINAHL, Global Health, Google Scholar, and grey literature from 2000 to February 19, 2021. The review was carried out under the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used the Appraisal of Indicators through Research and Evaluation (AIRE) tool for quality assessment. EVIDENCE SYNTHESIS A total of 5111 articles and 62 government agencies were screened for QI sets. There were a total of 57 QI sets included for analysis. Most QIs focused on uro-oncology, with prostate, bladder, and testicular cancers the most represented. The most common QIs were surgical QIs in uro-oncology (positive surgical margin, surgical volume), whereas in non-oncology the QIs most frequently reported were for treatment and diagnosis. Out of 61 articles, only four scored a total of ≥50% on the AIRE tool across four domains. Aside from QIs developed in uro-oncology, general urological QIs are underdeveloped and of poor methodological quality and most lack testing for both content validity and reliability. CONCLUSIONS There is an urgent need for the development of methodologically robust QIs in the clinical specialty of general urology for patients to enable standardised quality of care monitoring and to improve patient outcomes. PATIENT SUMMARY We investigated a range of quality indicators (QIs) that provide health care professionals with feedback on the quality of their care for patients with general urological diseases. We found that aside from urological cancers, there is a lack of QIs for general urology. Hence, there is an urgent need for the development of robust and disease-specific QIs in general urology.
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Affiliation(s)
- Harvey Jia Wei Koh
- Faculty of Information Technology, Monash University, Clayton, Australia; Digital Health Cooperative Research Centre, Sydney, Australia
| | - Emma Whitelock-Wainwright
- Faculty of Information Technology, Monash University, Clayton, Australia; Digital Health Cooperative Research Centre, Sydney, Australia
| | - Dragan Gasevic
- Faculty of Information Technology, Monash University, Clayton, Australia; Digital Health Cooperative Research Centre, Sydney, Australia
| | - David Rankin
- Digital Health Cooperative Research Centre, Sydney, Australia; Cabrini Healthcare, Malvern, Australia
| | - Lorena Romero
- Ian Potter Library, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Cabrini Institute, Cabrini Health, Malvern, Australia
| | - Sue Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Cancer Council Victoria, Melbourne, Australia
| | - Stella Talic
- Digital Health Cooperative Research Centre, Sydney, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Abera SF, Bedir A, Glowka A, Vordermark D, Medenwald D. Suboptimal use of hormonal therapy among German men with localized high-risk prostate Cancer during 2005 to 2015: analysis of registry data. BMC Cancer 2022; 22:624. [PMID: 35672732 PMCID: PMC9171996 DOI: 10.1186/s12885-022-09677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study assesses the use of hormonal therapy to treat high-risk localized prostate cancer (HRLPCa) cases diagnosed between 2005 and 2015. Methods All N0-XM0 with ≥T3a, or PCa cases with poorly differentiated feature (equivalent to Gleason score ≥ 8), diagnosed between 2005 and 2015 were extracted from German population-based cancer registries. Cases treated by surgery or chemotherapy were excluded. Description of hormonal therapy use by HRLPCa cases’ profile was presented. Relative risk (RR) was computed with a log-link function to identify factors associated with hormonal therapy use among radiotherapy-treated HRLPCa cases. Results A total of 5361 HRLPCa cases were analyzed. Only 27.6% (95% confidence interval [CI]: 26.4–28.8%) of the HRLPCa cases received hormonal therapy in combination with radiotherapy. The use of combined hormonal therapy and radiotherapy varied from 19.8% in Saxony to 47.8% in Schleswig-Holstein. Application of hormonal therapy was higher for the locally advanced cases compared to the poorly differentiated cases (relative risk [RR] = 1.28; 95%CI: 1.19, 1.37). Older patients showed a slightly increased use of hormonal therapy (RR for a 10-year age increase = 1.09; 95%CI: 1.02, 1.16). Compared to PCa cases from the most affluent residential areas, cases from the least affluent (RR = 0.71; 95%CI: 0.55, 0.92) and medium (RR = 0.75; 95%CI: 0.58, 0.96) areas had decreased use of hormonal therapy. The introduction of the German S3-guideline did not make a marked difference in the uptake of both hormonal therapy and radiotherapy (RR = 1.02; 95%CI: 0.95, 1.09). Conclusion This study found a low use of hormonal therapy among HRLPCa patients treated without surgery. The introduction of the German S3-guideline for prostate cancer treatment does not seem to have impacted hormonal therapy use. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09677-z.
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Affiliation(s)
- Semaw Ferede Abera
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
| | - Ahmed Bedir
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - André Glowka
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.,Department of Radiation Oncology, University Hospital Halle (Saale), Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.,Department of Radiation Oncology, University Hospital Halle (Saale), Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Daniel Medenwald
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.,Department of Radiation Oncology, University Hospital Halle (Saale), Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
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5
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Roessler M, Schmitt J, Bobeth C, Gerken M, Kleihues-van Tol K, Reissfelder C, Rau BM, Distler M, Piso P, Günster C, Klinkhammer-Schalke M, Schoffer O, Bierbaum V. Is treatment in certified cancer centers related to better survival in patients with pancreatic cancer? Evidence from a large German cohort study. BMC Cancer 2022; 22:621. [PMID: 35672675 PMCID: PMC9172168 DOI: 10.1186/s12885-022-09731-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Treatment of cancer patients in certified cancer centers, that meet specific quality standards in term of structures and procedures of medical care, is a national treatment goal in Germany. However, convincing evidence that treatment in certified cancer centers is associated with better outcomes in patients with pancreatic cancer is still missing. METHODS We used patient-specific information (demographic characteristics, diagnoses, treatments) from German statutory health insurance data covering the period 2009-2017 and hospital characteristics from the German Standardized Quality Reports. We investigated differences in survival between patients treated in hospitals with and without pancreatic cancer center certification by the German Cancer Society (GCS) using the Kaplan-Meier estimator and Cox regression with shared frailty. RESULTS The final sample included 45,318 patients with pancreatic cancer treated in 1,051 hospitals (96 GCS-certified, 955 not GCS-certified). 5,426 (12.0%) of the patients were treated in GCS-certified pancreatic cancer centers. Patients treated in certified and non-certified hospitals had similar distributions of age, sex, and comorbidities. Median survival was 8.0 months in GCS-certified pancreatic cancer centers and 4.4 months in non-certified hospitals. Cox regression adjusting for multiple patient and hospital characteristics yielded a significantly lower hazard of long-term, all-cause mortality in patients treated in GCS-certified pancreatic centers (Hazard ratio = 0.89; 95%-CI = 0.85-0.93). This result remained robust in multiple sensitivity analyses, including stratified estimations for subgroups of patients and hospitals. CONCLUSION This robust observational evidence suggests that patients with pancreatic cancer benefit from treatment in a certified cancer center in terms of survival. Therefore, the certification of hospitals appears to be a powerful strategy to improve patient outcomes in pancreatic cancer care. TRIAL REGISTRATION ClinicalTrials.gov ( NCT04334239 ).
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Affiliation(s)
- Martin Roessler
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Christoph Bobeth
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Michael Gerken
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg, Germany
| | | | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bettina M Rau
- Department of General, Visceral and Thoracic Surgery, Hospital of Neumarkt, Neumarkt in der Oberpfalz, Germany
| | - Marius Distler
- Technische Universität Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, Department of Visceral-, Thoracic and Vascular Surgery, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Barmherzige Brueder Hospital Regensburg, Regensburg, Germany
| | | | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg, Regensburg, Germany
| | - Olaf Schoffer
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Veronika Bierbaum
- Center for Evidence-Based Healthcare (ZEGV), Faculty of Medicine, University Hospital Carl Gustav Carus and Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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Predictors for the utilization of social service counseling by prostate cancer patients. Support Care Cancer 2021; 30:2327-2339. [PMID: 34738162 PMCID: PMC8568309 DOI: 10.1007/s00520-021-06620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/08/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE Social service counseling (SSC) is an important instrument to support cancer patients, for example, regarding legal support, or rehabilitation. Several countries have established on-site SSC in routine care. Previous analyses have shown that SSC utilization varies across cancer centers. This analysis investigates patient and center-level predictors that explain variations in SSC utilization between centers. METHODS Logistic multilevel analysis was performed with data from 19,865 prostate cancer patients from 102 prostate cancer centers in Germany and Switzerland. Data was collected within an observational study between July 2016 and June 2020 using survey (online and paper) and tumor documentation. RESULTS The intraclass correlation coefficient for the null model implies that 51% of variance in SSC utilization is attributable to the center a patient is treated in. Patients aged 80 years and older, with higher education, private insurance, without comorbidities, localized intermediate risk, and undergoing androgen deprivation therapy before study inclusion were less likely to utilize SSC. Undergoing primary radiotherapy, active surveillance, or watchful waiting as compared to prostatectomy was associated with a lower likelihood of SSC utilization. Significant negative predictors at the center level were university hospital, center's location in Switzerland, and a short period of certification. CONCLUSION The results show that patient and center characteristics contribute to explaining the variance in SSC utilization in prostate cancer centers to a large extent. The findings may indicate different organizational processes in the countries included and barriers in the sectoral structure of the healthcare system. In-depth analyses of processes within cancer centers may provide further insights into the reasons for variance in SSC utilization.
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Wesselmann S, Burchardt M, Kowalski C. From quality management to quality improvement-structures, processes and outcomes. World J Urol 2021; 39:1-3. [PMID: 33484271 DOI: 10.1007/s00345-021-03591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Simone Wesselmann
- Deutsche Krebsgesellschaft e. V., Kuno-Fischer-Street 8, 14057, Berlin, Germany.
| | - Martin Burchardt
- Universitatsklinikum Greifswald, Sauerbruchstraße street, 17475, Greifswald, Germany
| | - Christoph Kowalski
- Deutsche Krebsgesellschaft e. V., Kuno-Fischer-Street 8, 14057, Berlin, Germany
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