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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  ‡
1   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)
,
Pauline Wimberger‡
2   Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
3   National Center of Tumor Diseases (NCT) Dresden, Dresden
,
Michael Gerken
4   Tumorzentrum Regensburg, Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Germany (Ringgold ID: RIN9147)
,
Veronika Bierbaum
1   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)
,
Christoph Bobeth
1   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)
,
Martin Rößler
1   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)
,
Patrik Dröge
5   Wissenschaftliches Institut der AOK, Berlin, Germany
,
Thomas Ruhnke
5   Wissenschaftliches Institut der AOK, Berlin, Germany
,
Christian Günster
5   Wissenschaftliches Institut der AOK, Berlin, Germany
,
Kees Kleihues-van Tol
6   Arbeitsgemeinschaft Deutscher Tumorzentren e.V., Berlin, Germany
,
Theresa Link
2   Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
3   National Center of Tumor Diseases (NCT) Dresden, Dresden
,
Anton Scharl
7   Onkologische Fachklinik Bad Trissl, Oberaudorf, Germany
,
Elisabeth C. Inwald
8   Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Germany
,
Karin Kast 
9   Zentrum Familiärer Brust- und Eierstockkrebs und Centrum für Integrierte Onkologie, Universität zu Köln, Köln, Germany (Ringgold ID: RIN14309)
,
Thomas Papathemelis
10   Klinik für Frauenheilkunde und Geburtshilfe, Klinikum St. Marien Amberg, Amberg, Germany
,
Olaf Ortmann
8   Klinik für Frauenheilkunde und Geburtshilfe, Lehrstuhl der Universität Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Germany
,
Monika Klinkhammer-Schalke
4   Tumorzentrum Regensburg, Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Germany (Ringgold ID: RIN9147)
6   Arbeitsgemeinschaft Deutscher Tumorzentren e.V., Berlin, Germany
,
Jochen Schmitt
1   Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)
› Author Affiliations
Clinical Trial: Registration number (trial ID): NCT04334239, Trial registry: ClinicalTrials.gov, Type of Study:
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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

Supplementary Material



Publication History

Received: 14 August 2023

Accepted after revision: 16 November 2023

Article published online:
09 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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