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

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.

Translated title of the contributionThe value of ipsilateral breast tumor recurrence as a quality indicator: Hospital variation in the Netherlands
Original languageDutch
Article numberA9572
JournalNederlands tijdschrift voor geneeskunde
Volume160
Issue number5
Publication statusPublished - 1 Jan 2016

Fingerprint

Netherlands
Breast Neoplasms
Recurrence
Mastectomy
Quality of Health Care
Hospital Records
Registries
Neoplasms
Cohort Studies
Multivariate Analysis

Cite this

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].
Van Der Heiden-Van Der Loo, Margriet ; Siesling, Sabine ; Wouters, Michel W J M ; Van Dalen, Thijs ; Rutgers, Emiel J T ; Peeters, Petra H M. / Lokale recidieven na operatie voor borstkanker : Verbetering in recente jaren. In: Nederlands tijdschrift voor geneeskunde. 2016 ; Vol. 160, No. 5.
@article{9e970d5d1c5c4aa1bb39a5af474d508e,
title = "Lokale recidieven na operatie voor borstkanker: Verbetering in recente jaren",
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.",
author = "{Van Der Heiden-Van Der Loo}, Margriet and Sabine Siesling and Wouters, {Michel W J M} and {Van Dalen}, Thijs and Rutgers, {Emiel J T} and Peeters, {Petra H M}",
year = "2016",
month = "1",
day = "1",
language = "Dutch",
volume = "160",
journal = "Nederlands tijdschrift voor geneeskunde",
issn = "0028-2162",
publisher = "Bohn Stafleu Van Loghum",
number = "5",

}

Van Der Heiden-Van Der Loo, M, Siesling, S, Wouters, MWJM, Van Dalen, T, Rutgers, EJT & Peeters, PHM 2016, 'Lokale recidieven na operatie voor borstkanker: Verbetering in recente jaren' Nederlands tijdschrift voor geneeskunde, vol. 160, no. 5, A9572.

Lokale recidieven na operatie voor borstkanker : Verbetering in recente jaren. / Van Der Heiden-Van Der Loo, Margriet; Siesling, Sabine; Wouters, Michel W J M; Van Dalen, Thijs; Rutgers, Emiel J T; Peeters, Petra H M.

In: Nederlands tijdschrift voor geneeskunde, Vol. 160, No. 5, A9572, 01.01.2016.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Lokale recidieven na operatie voor borstkanker

T2 - Verbetering in recente jaren

AU - Van Der Heiden-Van Der Loo, Margriet

AU - Siesling, Sabine

AU - Wouters, Michel W J M

AU - Van Dalen, Thijs

AU - Rutgers, Emiel J T

AU - Peeters, Petra H M

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84956928478&partnerID=8YFLogxK

M3 - Article

VL - 160

JO - Nederlands tijdschrift voor geneeskunde

JF - Nederlands tijdschrift voor geneeskunde

SN - 0028-2162

IS - 5

M1 - A9572

ER -

Van Der Heiden-Van Der Loo M, Siesling S, Wouters MWJM, Van Dalen T, Rutgers EJT, Peeters PHM. Lokale recidieven na operatie voor borstkanker: Verbetering in recente jaren. Nederlands tijdschrift voor geneeskunde. 2016 Jan 1;160(5). A9572.