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. 2018 Apr 12;13(4):e0195673.
doi: 10.1371/journal.pone.0195673. eCollection 2018.

What drives centralisation in cancer care?

Melvin J Kilsdonk  1   2 , Sabine Siesling  1   2 , Boukje A C van Dijk  1   3 , Michel W Wouters  4 , Wim H van Harten  2   4
Affiliations

What drives centralisation in cancer care?

Melvin J Kilsdonk et al. PLoS One. .

Abstract

Background: To improve quality of care, centralisation of cancer services in high-volume centres has been stimulated. Studies linking specialisation and high (surgical) volumes to better outcomes already appeared in the 1990's. However, actual centralisation was a difficult process in many countries. In this study, factors influencing the centralisation of cancer services in the Netherlands were determined.

Material and methods: Centralisation patterns were studied for three types of cancer that are known to benefit from high surgical caseloads: oesophagus-, pancreas- and bladder cancer. The Netherlands Cancer Registry provided data on tumour and treatment characteristics from 2000-2013 for respectively 8037, 4747 and 6362 patients receiving surgery. By plotting timelines of centralisation of cancer surgery, relations with the appearance of (inter)national scientific evidence, actions of medical specialist societies, specific regulation and other important factors on the degree of centralisation were ascertained.

Results: For oesophagus and pancreas cancer, a gradual increase in centralisation of surgery is seen from 2005 and 2006 onwards following (inter)national scientific evidence. Centralisation steps for bladder cancer surgery can be seen in 2010 and 2013 anticipating on the publication of norms by the professional society. The most influential stimulus seems to have been regulations on minimum volumes.

Conclusion: Scientific evidence on the relationship between volume and outcome lead to the start of centralisation of surgical cancer care in the Netherlands. Once a body of evidence has been established on organisational change that influences professional practice, in addition some form of regulation is needed to ensure widespread implementation.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Total number of oesophagectomies and pancreatectomies from 2000–2013 and cystectomies from 2005–2013 in the Netherlands.
Fig 2
Fig 2. Changes in surgical volumes from 2000–2013: Oesophageal resections and relevant external stimuli.
Significant trendbreak in 2005 (for cumulative categories ≥10 and ≥ 20 procedures).
Fig 3
Fig 3. Changes in surgical volumes from 2000–2013: Pancreas resections and relevant external stimuli.
Significant trendbreak in 2006 (for cumulative categories ≥10 and ≥ 20 procedures).
Fig 4
Fig 4. Changes in surgical volumes from 2005–2013: Cystectomies and relevant external stimuli.
See this image and copyright information in PMC

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