TY - JOUR
T1 - Level of hospital care and outcome of gastric cancer
T2 - A population-based evaluation of the Munich Cancer Registry
AU - Schlesinger-Raab, Anne
AU - Mihaljevic, André L.
AU - Egert, Silvia
AU - Emeny, Rebecca T.
AU - Jauch, Karl Walter
AU - Kleeff, Jörg
AU - Novotny, Alexander
AU - Nüssler, Natascha C.
AU - Rottmann, Miriam
AU - Schepp, Wolfgang
AU - Schmitt, Wolfgang
AU - Schubert-Fritschle, Gabriele
AU - Weber, Bernhard
AU - Schuhmacher, Christoph
AU - Engel, Jutta
PY - 2014/5
Y1 - 2014/5
N2 - Background: Gastric cancer accounts for 5 % of cancer deaths. Successful implementation of guideline-recommended treatment procedures should result in population-based outcome improvements despite the still poor prognosis. In this context, the objective of this study was to compare the outcome of gastric cancer by different levels of hospital care. Materials and methods: Total of 8,601 patients with invasive gastric cancer documented between 1998 and 2012 by the Munich Cancer Registry were evaluated. Tumour and therapy characteristics and outcome were analysed in regard to five levels of hospital care: three levels were defined for general hospitals (level I-III), while university hospitals and speciality hospitals were grouped as separate classes. Survival was investigated using the Kaplan-Meier-method, computing relative survival, and by multivariate Cox proportional hazard regression. Results: The average age differed between 66 years in university hospitals and 75 years in hospitals providing a basic level of care (level I). No survival differences were found for patients treated in different levels of hospital care in 75 % of the patient cohort, namely the M0 patients. A better survival could only be shown for patients with M1 at diagnosis when treated in a university or level III hospital compared to those treated in other hospitals. Conclusion: The outcome difference of M1 patients is most likely caused by selection effects concerning health status differences and not by processes of health care attributable to level of hospital care. Thus, this study demonstrates and confirms appropriate treatment and care of gastric cancer over all levels of hospital care.
AB - Background: Gastric cancer accounts for 5 % of cancer deaths. Successful implementation of guideline-recommended treatment procedures should result in population-based outcome improvements despite the still poor prognosis. In this context, the objective of this study was to compare the outcome of gastric cancer by different levels of hospital care. Materials and methods: Total of 8,601 patients with invasive gastric cancer documented between 1998 and 2012 by the Munich Cancer Registry were evaluated. Tumour and therapy characteristics and outcome were analysed in regard to five levels of hospital care: three levels were defined for general hospitals (level I-III), while university hospitals and speciality hospitals were grouped as separate classes. Survival was investigated using the Kaplan-Meier-method, computing relative survival, and by multivariate Cox proportional hazard regression. Results: The average age differed between 66 years in university hospitals and 75 years in hospitals providing a basic level of care (level I). No survival differences were found for patients treated in different levels of hospital care in 75 % of the patient cohort, namely the M0 patients. A better survival could only be shown for patients with M1 at diagnosis when treated in a university or level III hospital compared to those treated in other hospitals. Conclusion: The outcome difference of M1 patients is most likely caused by selection effects concerning health status differences and not by processes of health care attributable to level of hospital care. Thus, this study demonstrates and confirms appropriate treatment and care of gastric cancer over all levels of hospital care.
KW - Cancer registry
KW - Comparative effectiveness research
KW - Gastric cancer
KW - Health care
KW - Level of hospital care
KW - Stomach cancer
UR - http://www.scopus.com/inward/record.url?scp=84901602719&partnerID=8YFLogxK
U2 - 10.1007/s00432-014-1632-4
DO - 10.1007/s00432-014-1632-4
M3 - Article
C2 - 24633864
AN - SCOPUS:84901602719
SN - 0171-5216
VL - 140
SP - 789
EP - 800
JO - Journal of Cancer Research and Clinical Oncology
JF - Journal of Cancer Research and Clinical Oncology
IS - 5
ER -
