Treatment in Certified Breast Cancer Centers Improves Chances of Survival of Patients with Breast Cancer

Olaf Schoffer; Pauline Wimberger; Michael Gerken; Veronika Bierbaum; Christoph Bobeth; Martin Rößler; Patrik Dröge; Thomas Ruhnke; Christian Günster; Kees Kleihues-van Tol; Theresa Link; Anton Scharl; Elisabeth C. Inwald; Karin Kast; Thomas Papathemelis; Olaf Ortmann; Monika Klinkhammer-Schalke; Jochen Schmitt

doi:10.1055/a-1869-1772

Geburtshilfe und Frauenheilkunde, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2024; 84(02): 153-163
DOI: 10.1055/a-1869-1772

GebFra Science

Original Article

Treatment in Certified Breast Cancer Centers Improves Chances of Survival of Patients with Breast Cancer

Evidence Based on Health Care Data from the WiZen Study Article in several languages: English | deutsch

Olaf Schoffer ‡

¹Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)

,

Pauline Wimberger‡

²Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany

³National Center of Tumor Diseases (NCT) Dresden, Dresden

,

Michael Gerken

⁴Tumorzentrum Regensburg, Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Germany (Ringgold ID: RIN9147)

,

Veronika Bierbaum

¹Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)

,

Christoph Bobeth

¹Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)

,

Martin Rößler

¹Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)

,

Patrik Dröge

⁵Wissenschaftliches Institut der AOK, Berlin, Germany

,

Thomas Ruhnke

⁵Wissenschaftliches Institut der AOK, Berlin, Germany

,

Christian Günster

⁵Wissenschaftliches Institut der AOK, Berlin, Germany

,

Kees Kleihues-van Tol

⁶Arbeitsgemeinschaft Deutscher Tumorzentren e.V., Berlin, Germany

,

Theresa Link

²Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany

³National Center of Tumor Diseases (NCT) Dresden, Dresden

,

Anton Scharl

⁷Onkologische Fachklinik Bad Trissl, Oberaudorf, Germany

,

Elisabeth C. Inwald

⁸Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Germany

,

Karin Kast

⁹Zentrum Familiärer Brust- und Eierstockkrebs und Centrum für Integrierte Onkologie, Universität zu Köln, Köln, Germany (Ringgold ID: RIN14309)

,

Thomas Papathemelis

¹⁰Klinik für Frauenheilkunde und Geburtshilfe, Klinikum St. Marien Amberg, Amberg, Germany

,

Olaf Ortmann

⁸Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Germany

,

Monika Klinkhammer-Schalke

⁴Tumorzentrum Regensburg, Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Germany (Ringgold ID: RIN9147)

⁶Arbeitsgemeinschaft Deutscher Tumorzentren e.V., Berlin, Germany

,

Jochen Schmitt

¹Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)

› Author Affiliations

Abstract

Introduction

Certified breast cancer centers offer specific quality standards in terms of their structure, diagnostic and treatment approaches with regards to breast surgery, drug-based cancer therapy, radiotherapy, and psychosocial support. Such centers aim to improve treatment outcomes of breast cancer patients. The question investigated here was whether patients with primary breast cancer have a longer overall survival if they are treated in a certified breast cancer center compared to treatment outside these centers.

Methods

We used patient-specific data (demographics, diagnoses, treatments) obtained from data held by mandatory health insurance companies (gesetzliche Krankenversicherung, GKV) and clinical cancer registries (KKR) for the period 2009–2017 as well as hospital characteristics recorded in standardized quality reports. Using multivariable Cox regression analysis, we investigated differences in survival between patients treated in hospitals certified as breast cancers centers by the German Cancer Society (DKG) and patients treated in hospitals which had not been certified by the DKG.

Results

The sample population consisted of 143720 (GKV data) and 59780 (KKR data) patients with breast cancer, who were treated in 1010 hospitals across Germany (280 DKG-certified, 730 not DKG-certified). 63.5% (GKV data) and 66.7% (KKR data) of patients, respectively, were treated in DKG-certified breast cancer centers. Cox regression analysis for overall survival which included patient and hospital characteristics found a significantly lower mortality risk for patients treated in DKG-certified breast cancer centers (GKV data: HR = 0.77, 95% CI = 0.74–0.81; KKR data: HR = 0.88, 95% CI = 0.85–0.92). This result remained stable even after several sensitivity analyses including stratified estimates for subgroups of patients and hospitals. The effect was even more pronounced for recurrence-free survival (KKR data: HR = 0.78, 95% CI = 0.74–0.82).

Conclusions

Patients who are treated by an interdisciplinary team in a DKG-certified breast cancer had clear and statistically significantly better survival rates. Certification is therefore an effective means of improving the quality of care, and more patients should be treated in certified breast cancer centers.

Keywords

breast cancer - certification - outcome quality - health care research - health care-related data

Full Text

References

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Supplementary Material

Supplementary material