Lokale recidieven na operatie voor borstkanker: Verbetering in recente jaren

Translated title of the contribution: The value of ipsilateral breast tumor recurrence as a quality indicator: Hospital variation in the Netherlands

Margriet Van Der Heiden-Van Der Loo*, Sabine Siesling, Michel W J M Wouters, Thijs Van Dalen, Emiel J T Rutgers, Petra H M Peeters

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: All Dutch hospitals are obliged to report their 5-year ipsilateral breast tumor recurrence (IBTR) rate after breast cancer surgery. Experts decided that these rates should not exceed 5%. This study determined the value of IBTR as an indicator to compare quality of care between hospitals. Design: Cohort study Method: All patients with breast cancer (pT1-3, any N, M0) who underwent surgery in 1 of 92 Dutch hospitals from 2003 to 2006 were identified in the Netherlands Cancer Registry. Data of recurrence was retrieved from hospital records. Five-year IBTR rates for breastconserving surgery (BCS) and mastectomy were calculated using the Kaplan-Meier method. Hospital variation was presented in funnel plots. Multivariate analysis was used to assess hospital characteristics associated with IBTR rates. Result: A total of 40,892 breast cancer patients were included. The overall 5-year IBTR rate was 2.85% (95%-CI 2.68-3.03) and was significantly lower for BCS than for mastectomy (2.38% vs 3.45%, p < 0.001). IBTR rates decreased over time in both groups. Rates varied between 0.77 and 5.70% between hospitals. When random variation is taken into account, only extremely high IBTR rates can be detected as deviant from the target value of 5%. Adjusting for tumor and patient characteristics, analyses showed that a higher volume of mastectomies is associated with lower IBTR rates. Conclusion: Our populationbased findings show that IBTR rates in the Netherlands are low and have improved over time. The 5-year IBTR rate as an indicator for quality of care of individual hospitals is of limited value.

Original languageDutch
Article numberA9572
JournalNederlands tijdschrift voor geneeskunde
Volume160
Issue number5
Publication statusPublished - 1 Jan 2016

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    Van Der Heiden-Van Der Loo, M., Siesling, S., Wouters, M. W. J. M., Van Dalen, T., Rutgers, E. J. T., & Peeters, P. H. M. (2016). Lokale recidieven na operatie voor borstkanker: Verbetering in recente jaren. Nederlands tijdschrift voor geneeskunde, 160(5), [A9572].