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. 2023 Oct;49(10):107019.
doi: 10.1016/j.ejso.2023.107019. Epub 2023 Aug 12.

The association between hospital variation in curative treatment for esophagogastric cancer and health-related quality of life and survival

Pauline A J Vissers  1 , Josianne C H B M Luijten  2 , Valery E P P Lemmens  3 , Hanneke W M van Laarhoven  4 , Marije Slingerland  5 , Bas P L Wijnhoven  6 , C Rosman  7 , Stella Mook  8 , Joos Heisterkamp  9 , Ellen M Hendriksen  10 , Suzanne S Gisbertz  11 , Grard A P Nieuwenhuijzen  12 , Rob H A Verhoeven  13
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Free article

The association between hospital variation in curative treatment for esophagogastric cancer and health-related quality of life and survival

Pauline A J Vissers et al. Eur J Surg Oncol. 2023 Oct.
Free article

Abstract

Background: As previous studies showed significant hospital variation in curative treatment of esophagogastric cancer, this study assesses the association between this variation and overall, cancer-specific and recurrence-free survival, and Health-Related Quality of Life (HRQoL).

Methods: Patients diagnosed with potentially curable esophageal or gastric cancer between 2015 and 2018 as registered in the Netherlands Cancer Registry were included. Data on overall survival was available for all patients, data on cancer-specific and recurrence-free survival and HRQoL was available for subgroups. Patients were classified according to diagnosis in hospitals with low, medium or high probability of treatment with curative intent (LP, MP or HP). Multivariable models were used to assess the association between LP, MP and HP hospitals and HRQoL and survival.

Results: This study includes 7,199 patients with esophageal, and 2,407 with gastric cancer. Overall and cancer-specific survival was better for patients diagnosed in HP versus LP hospitals for both esophageal (HR = 0.82, 95%CI:0.77-0.88 and HR = 0.82, 95%CI:0.75-0.91, respectively), and gastric cancer (HR = 0.82, 95%CI:0.73-0.92 and HR = 0.74, 95%CI:0.64-0.87, respectively). These differences disappeared after adjustments for treatment. Recurrence-free survival was worse for gastric cancer patients diagnosed in HP hospitals (HR = 1.50, 95%CI:1.14-1.96), which disappeared after adjustment for radicality of surgery. Minor, but no clinically relevant, differences in HRQoL were observed.

Conclusions: Patients diagnosed in hospitals with a high probability of treatment with curative intent have a better overall and cancer-specific but not recurrence-free survival, while minor differences in HRQoL were observed.

Keywords: Esophagogastric cancer; Health-related quality of life; Survival.

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Conflict of interest statement

Declaration of competing interest RV received a research grant from Bristol Myers Squibb and has served as consultant for Daiichi Sankyo. HvL reports grants or advisory/speaker role from: Astellas, BMS, Daiichy, Dragonfly, Lilly, Merck, Novartis, Nordic Pharma, Servier; research funding or medical supply from: Bayer, BMS, Celgene, Janssen, Incyte, Lilly, Merck, Nordic Pharma, Philips, Roche, Servier; and has received unrestricted research funding (non-commercial) from: Dutch Cancer Society, NWO/ZonMw, European Research Council, MaagLeverDarm Stichting. GN reports grants or advisory/speaker role from: Medtronic and Lilly and has received unrestricted research funding (non-commercial) from: Dutch Cancer Society and CZ Healthcare Insurance. MS reports an advisory role for Lilly and BMS. BW reports research grant and speaker role from BMS. The other authors have nothing to declare.

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