Quality-assured treatment in certified cancer center networks in upper Franconia, Germany: a population-centered retrospective cohort analysis based on data of the Bavarian cancer registry

Our plain-English summary of Quality-assured treatment in certified cancer center networks in upper Franconia, Germany: a population-centered retrospective cohort analysis based on data of the Bavarian cancer registry, by M. Emmert, I. Gorodiscan, A. Thater, et al (BMC Health Services Research, 2024).

The study

• Authors: M. Emmert, I. Gorodiscan, A. Thater, D. Buchner, A. Kiani, J. Müller-Nordhorn, S. Rohrbacher
• Journal: BMC Health Services Research
• Published: 2024;24(1):1453
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Cancer is the second most common cause of death in Germany, and treatment in certified cancer networks is recommended to ensure high-quality care. This study sought to (1) determine the percentage of all primary tumors that might potentially have been treated in certified cancer networks and (2) assess the development and current state of quality-assured cancer care for all cancer patients from a locally defined region in Upper Franconia, Germany.

Methods: This study was a population-centered retrospective cohort analysis based on data from the Bavarian Cancer Registry (2017-2023). First, we determined all potentially available cancer network certifications and calculated the percentage of cancer care that could potentially have been conducted in certified cancer networks. Second, we considered the certification status of the involved healthcare providers and analyzed whether or not cancer care was actually carried out in certified cancer networks.

Results: Overall, 90.1% (62,119/68,973) of all primary tumors, from a total of 63,372 patients, might potentially have been treated in certified cancer networks. The percentage of patients actually receiving care in certified cancer center networks was 40.7% for initial diagnosis, 59.0% for surgery, 53.2% for chemotherapy, and 50.7% for radiotherapy; the weighted mean was 50.3%. The results thus ranged between 46.9% (2023) and 52.8% (2022). The highest proportions of patients who received quality-assured treatment in certified cancer center networks were determined for breast cancer (79.5%), colon cancer (73.1%), and lymphoma (60.1%); in contrast, the lowest results were shown for lung cancer (2.7%), anal cancer (0.0%), and mesothelioma (0.0%). Female patients as well as younger patients were significantly more likely to receive care in certified care networks compared with their counterparts. In addition, we did not find a clear trend whether patients in different tumor stages were more or less likely to receive care in certified care networks.

Conclusions: We found meaningful differences in the proportion of patients who received quality-assured treatment in certified cancer center networks. Following this, patients should receive comprehensive information about receiving care in certified cancer center networks and consider longer travel distances, especially for those cancer types without locally available certified cancer networks.

© 2024. The Author(s).

In plain English

This study did not examine asbestos. It was a retrospective cohort analysis of Bavarian Cancer Registry data on adults in Upper Franconia, Germany, with a cancer-related diagnosis or treatment recorded between April 2017 and December 2023. It covered 63,372 patients with 68,973 primary tumors. Of these tumors, 90.1% could potentially have been treated in certified cancer networks. Among those patients, 40.7% of initial diagnoses, 59.0% of surgeries, 53.2% of chemotherapy and 50.6% of radiotherapy took place in certified networks (50.3% overall). The share was highest for breast cancer (79.5%). It was lowest for lung cancer (2.7%), anal cancer (0.0%) and mesothelioma (0.0%, 95% CI 0.0% to 1.5%). The region had no lung cancer center. Women (59.7%) were more likely than men (41.3%) to receive certified care, and older patients were less likely. There was no clear trend by tumor stage or by year. The authors noted that tumor stage was missing for about half of tumors and that erroneous data could not be excluded. They concluded there were meaningful differences in the proportion of patients receiving quality-assured care.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Population-centered retrospective cohort analysis of cancer registry data (health services research)
• Who was studied: 63,372 patients over 18 with 68,973 primary tumors (ICD-10 C00-D48), residing in Upper Franconia, Germany, with cancer-related diagnosis or treatment information between April 2017 and December 2023. Some were diagnosed before April 2017 but treated afterwards.
• Exposure: Not an asbestos exposure. The study looked at whether each diagnosis, surgery, chemotherapy or radiotherapy was delivered in a certified cancer network, based on the providers' certification status at the time of care.
• Main results:
  • 90.1% (62,119/68,973) of all primary tumors could potentially have been treated in certified cancer networks
  • Among patients who could potentially have been treated in certified networks, the share receiving care in certified networks was 40.7% for initial diagnosis, 59.0% for surgery, 53.2% for chemotherapy and 50.6% for radiotherapy
  • Overall, 50.3% (95% CI 50.1% to 50.5%) of all cancer-related diagnoses and treatments (79,466/157,871) were conducted in certified structures
  • The highest proportion of patients receiving care in certified networks was for breast cancer: 79.5% (95% CI 79.0% to 80.0%)
  • The lowest proportions were for lung cancer at 2.7% (95% CI 2.4% to 3.0%), anal cancer at 0.0% (95% CI 0.0% to 3.2%) and mesothelioma at 0.0% (95% CI 0.0% to 1.5%)
  • There was still no lung cancer center in Upper Franconia
  • Female patients were more likely to receive care in certified networks: 59.7% (95% CI 59.3% to 60.1%)
  • The corresponding figure for male patients was 41.3% (95% CI 40.9% to 41.6%)
  • Older patients were less likely to receive cancer care in certified structures
  • There was no clear trend by tumor stage (I to IV)
  • By year, the share treated in certified networks ranged from 46.9% (2023) to 52.8% (2022), with no clear trend
• The authors' conclusion: The authors concluded that there were meaningful differences in the proportion of patients who received quality-assured treatment in certified cancer center networks
• Limitations the authors state:
  • Because the study used retrospective secondary data, the authors could not exclude missing and erroneous data
  • Tumor stage (UICC) information was available for only around half of all tumors
  • The study was conducted in Germany and may be of limited relevance for other countries

Topics

Medical terms in this study, explained in our Lexicon: Cancer Registry, Chemotherapy, Colorectal Cancer, Lung Cancer, Mesothelioma.

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