P14.40 Trends in distribution of glioblastoma care and patient’s travel distance; results from the Dutch Brain Tumor Registry

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii46-ii46
Author(s):  
M E De Swart ◽  
V K Y Ho ◽  
F J Lagerwaard ◽  
D Brandsma ◽  
M P Broen ◽  
...  
Keyword(s):  
Brain Tumor ◽  
The Netherlands ◽  
High Volume ◽  
Travel Distance ◽  
Tumor Registry ◽  
Number Of Patients ◽  
Oncology Care ◽  
Time Periods ◽  
The Impact ◽  
Travel Distances

Abstract BACKGROUND Over the past years, increasing worldwide attention towards centralization of complex cancer care has been pursued as higher volume centers have shown improved outcomes. Changes in distribution of care and the impact on travel distance in glioblastoma patients have not been determined yet. In this study, we determine trends in distribution of glioblastoma care in the Netherlands over the last three decades and assess whether the observed trends affected travel distance for individual patients. MATERIAL AND METHODS Data were obtained from the Dutch Brain Tumor Registry from 1989 to 2018. All glioblastoma patients (≥18 years) were included for analysis. Patients, neurosurgical centers and radiotherapy centers were geocoded. Data were analyzed in six time intervals of 5 years. High volume hospitals were defined as >50 cases per year. Travel distance was examined in two categories, ≤60km and >60km respectively. Trend analyses for proportions were used to analyze hospital volume changes and travel distances. RESULTS A total of 16.477 glioblastoma patients were registered, with an annual increase from 203 patients in 1989 to 917 patients in 2018. Neurosurgical centers increased from 16 to 17 and for radiotherapy from 19 to 22 centers between 1989–1993 and 2014–2018. Mean neurosurgical- and radiotherapy center volumes increased from 12 to 39 (P=0.025) and 7 to 27 (P=0.025) patients per hospital per year from 1989–1993 to 2014–2018. High volume neurosurgical centers were observed since 2004, and an increased number of patients were treated in these centers, 27.8%, 52.6% and 64.1% in the time periods 2004–2008, 2009–2013, and 2014–2018 (P<0.001). High volume radiology centers were observed since 2009, and 15.0% and 27.3% of patients were treated in these centers in the time periods 2009–2013 and 2014–2018 (P<0.001). Patients with a travel distance >60km to the neurosurgical center reduced from 15.8% to 13.2% (P=0.033). Travel distance >60km to the radiotherapy center did not reduce significantly (10.4% to 8.8%, P=0.601). CONCLUSION An increasing number of glioblastoma patients were differentially treated in high volume neurosurgery and radiotherapy centers. The observation that this did not translate into increased travel distances, indicates accessible specialized Neuro-Oncology care for glioblastoma patients in The Netherlands.

scholarly journals Impact of Pharmacy Benefit Managers on Oncology Practices and Patients

2020 ◽  
Vol 16 (5) ◽  
pp. 276-284 ◽  
Author(s):  
Trevor J. Royce ◽  
Caroline Schenkel ◽  
Kelsey Kirkwood ◽  
Laura Levit ◽  
Kathryn Levit ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Prescription Drugs ◽  
Business Practices ◽  
Pharmacy Benefit ◽  
Drug Benefits ◽  
Quality Cancer Care ◽  
Number Of Patients ◽  
Oncology Care ◽  
The Impact

Pharmacy benefit managers (PBMs) are thoroughly integrated into the drug supply chain as administrators of prescription drug benefits for private insurers, self-insuring business, and government health plans. As the role of PBMs has expanded, their opaque business practices and impact on drug prices have come under increasing scrutiny. PBMs are particularly influential in oncology care because prescription drugs play a major role in the treatment of most cancers and an increasing number of patients with cancer are treated with oral oncology agents managed by PBMs. There is concern that some PBM practices may threaten access to high-quality cancer care and may increase the financial and administrative burden on patients and practices. In this article, we review the role of PBMs in prescription drug coverage and reimbursement, discuss the impact of PBMs on oncology care, and present data from the 2018 ASCO Practice Survey assessing the knowledge and attitude of oncology practices toward PBMs.

scholarly journals Preventive treatment for migraine in primary care, a population-based study in the Netherlands

Cephalalgia ◽  
2013 ◽  
Vol 33 (14) ◽  
pp. 1170-1178 ◽  
Author(s):  
F Dekker ◽  
JP Dieleman ◽  
A Knuistingh Neven ◽  
MD Ferrari ◽  
WJJ Assendelft
Keyword(s):  
Primary Care ◽  
The Netherlands ◽  
Clinical Information ◽  
Preventive Treatment ◽  
Preventive Therapy ◽  
Source Population ◽  
Research Database ◽  
Number Of Patients ◽  
Prior Use ◽  
The Impact

Background Preventive treatment of migraine contributes to reducing the impact of migraine but its extent of use in routine care is unknown. Objective The objective of this article is to assess current use, previous use, duration and course of preventive treatment of migraine in Dutch general practice. Methods We conducted a retrospective cohort study, for the period between 1997 and 2007, in the Interdisciplinary Processing of Clinical Information (IPCI) database, a GP research database in the Netherlands (source population of more than half a million subjects). All prevalent and incident migraine patients ( N = 7367) were included. Results About 13% of all migraine patients currently use preventive therapy and almost half of migraine patients have prior use. Of those starting with preventive treatment, 56% (95% CI: 54.3–64.7) still used it after nine months. There was a long delay between migraine diagnosis and preventive treatment start. Forty-four percent (95% CI 43.0–45.7) started preventive therapy in the study period. Conclusion This large primary-care database study shows that a limited number of patients are current users of preventive treatment, but many patients have prior use. After diagnosis there is often an extended time before preventive treatment is applied. Also there is often only one attempt. The continuation in time seems appropriate. Preventive therapy in migraine still deserves focus.

P14.31 Between hospital variation in timings to multidisciplinary glioblastoma care in the Dutch Brain Tumor Registry

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii44-ii44
Author(s):  
M E De Swart ◽  
V K Y Ho ◽  
F J Lagerwaard ◽  
D Brandsma ◽  
M P Broen ◽  
...  
Keyword(s):  
Brain Tumor ◽  
The Netherlands ◽  
Multidisciplinary Treatment ◽  
Case Mix ◽  
National Guidelines ◽  
Tumor Registry ◽  
Hospital Variation ◽  
Long Time ◽  
Newly Diagnosed Glioblastoma ◽  
Brain Tumor Diagnosis

Abstract BACKGROUND Delay in cancer care may adversely affect emotional distress, treatment outcome and survival. Optimal timings in multidisciplinary glioblastoma care are a matter of debate and clear national guidelines only exist for time to neurosurgery. We evaluated the between-hospital variation in timings to neurosurgery and adjuvant radiotherapy and chemotherapy in newly diagnosed glioblastoma patients in the Netherlands. MATERIAL AND METHODS Data were obtained from the nation-wide Dutch Brain Tumor Registry between 2014 and 2018. All adult patients with glioblastoma were included, covering all 18 neurosurgical hospitals, 28 radiotherapy hospitals, and 33 oncology hospitals. Long time-to-surgery (TTS) was defined as >3 weeks from the date of first brain tumor diagnosis to surgery, long time-to-radiotherapy (TTR) as either >4 or >6 weeks after surgery, and long time-to-chemotherapy (TTC) as either >4 or >6 weeks after completion of radiotherapy. Between-hospital variation in standardized rate of long timings was analyzed in funnel plots after case-mix correction. RESULTS A total of 4203 patients were included. Median TTS was 20 days and 52.4% of patients underwent surgery within 3 weeks. Median TTR was 20 days and 24.6% of patients started radiotherapy within 4 weeks and 84.2% within 6 weeks after surgery. Median TTC was 28 days and 62.6% of patients received chemotherapy within 4 weeks and 91.8% within 6 weeks after radiotherapy. After case-mix correction, three (16.7%) neurosurgical hospitals had significantly more patients with longer than expected TTS. Three (10.7%) and one (3.6%) radiotherapy hospitals had significantly more patients with longer than expected TTR for >4 and >6 weeks, respectively. In seven (21.2%) chemotherapy hospitals, significantly less patients with TTC >4 weeks were observed than expected. In four (12.1%) chemotherapy hospitals, significantly more patients with TTC >4 weeks were observed than expected. CONCLUSION Between-hospital variation in timings to multidisciplinary treatment was observed in glioblastoma care in the Netherlands. A substantial percentage of patients experienced timings longer than anticipated.

scholarly journals Impact of obstetric unit closures, travel time and distance to obstetric services on maternal and neonatal outcomes in high-income countries: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e036852
Author(s):  
Reem Saleem Malouf ◽  
Claire Tomlinson ◽  
Jane Henderson ◽  
Charles Opondo ◽  
Peter Brocklehurst ◽  
...  
Keyword(s):  
Systematic Review ◽  
Grey Literature ◽  
Risk Of Bias ◽  
High Income ◽  
Travel Distance ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Maternal And Neonatal Outcomes ◽  
The Impact ◽  
Travel Distances

ObjectivesTo systematically review (1) The effect of obstetric unit (OU) closures on maternal and neonatal outcomes and (2) The association between travel distance/time to an OU and maternal and neonatal outcomes.DesignSystematic review of any quantitative studies with a comparison group.Data sourcesEmbase, MEDLINE, PsycINFO, Applied Social Science Index and Abstracts, Cumulative Index to Nursing and Allied Health and grey literature were searched.MethodsEligible studies explored the impact of closure of an OU or the effect of travel distance/time on prespecified maternal or neonatal outcomes. Only studies of women giving birth in high-income countries with universal health coverage of maternity services comparable to the UK were included. Identification of studies, extraction of data and risk of bias assessment were undertaken by at least two reviewers independently. The risk of bias checklist was based on the Cochrane Effective Practice and Organisation of Care criteria and the Newcastle-Ottawa scale. Heterogeneity across studies precluded meta-analysis and synthesis was narrative, with key findings tabulated.Results31 studies met the inclusion criteria. There was some evidence to suggest an increase in babies born before arrival following OU closures and/or associated with longer travel distances or time. This may be associated with an increased risk of perinatal or neonatal mortality, but this finding was not consistent across studies. Evidence on other maternal and neonatal outcomes was limited but did not suggest worse outcomes after closures or with longer travel times/distances. Interpretation of findings for some studies was hampered by concerns around how accurately exposures were measured, and/or a lack of adjustment for confounders or temporal changes.ConclusionIt is not possible to conclude from this review whether OU closure, increased travel distances or times are associated with worse outcomes for the mother or the baby.PROSPERO registration numberCRD42017078503.

771 IMPACT OF NATIONWIDE CENTRALIZATION OF ESOPHAGEAL, GASTRIC, AND PANCREATIC SURGERY ON TRAVEL DISTANCE AND EXPERIENCED BURDEN IN THE NETHERLANDS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Josianne Luijten ◽  
Grard Nieuwenhuijzen ◽  
Meindert Sosef ◽  
Ignace Hingh ◽  
Camiel Rosman ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
The Netherlands ◽  
Surgical Care ◽  
Global Scale ◽  
Travel Distance ◽  
Logistic Regression Models ◽  
Social Burden ◽  
Cancer Types ◽  
The Impact ◽  
Travel Burden

Abstract   This study aims to assess the impact of nationwide centralization of surgery on travel distance and travel burden among patients with esophageal-, gastric-, and pancreatic cancer according to age in the Netherlands. As centralization of care increases to improve postoperative outcomes, travel distance and experienced burden might increase. Methods All patients who underwent surgery between 2006–2017 for esophageal-, gastric- and pancreatic cancer in the Netherlands were included. Travel distance between patient’s home address and hospital of surgery in kilometers was calculated. Questionnaires were used to assess experienced travel burden in a subpopulation (n = 239). Multivariable ordinal logistic regression models were constructed to identify predictors for longer travel distance. Results Over 23,838 patients were included, in whom median travel distance for surgical care increased for esophageal cancer (n = 9,217) from 18 to 28 km, for gastric cancer (n = 6,743) from 9 to 26 km and for pancreatic cancer (n = 7,878) from 18 to 25 km (all p < 0.0001). Multivariable analyses showed an increase in travel distance for all cancer types over time. In general, patients experienced a physical and social burden, and higher financial costs, due to travelling extra kilometers. Patients aged >70 years travelled less often independently (56% versus 68%), as compared to patients aged ≤70 years. Conclusion With nationwide centralization, travel distance increased for patients undergoing esophageal-, gastric-, and pancreatic cancer surgery. Younger patients travelled longer distances and experienced a lower travel burden, as compared to elderly patients. Nevertheless, on a global scale travel distances in the Netherlands remain limited.

scholarly journals Effect of the COVID-19 pandemic during the first lockdown in the Netherlands on the number of trauma-related admissions, trauma severity and treatment: the results of a retrospective cohort study in a level 2 trauma centre

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045015
Author(s):  
Gijs J.J. van Aert ◽  
Lijckle van der Laan ◽  
Leandra J.M. Boonman-de Winter ◽  
Cornelis A.S. Berende ◽  
Hans G.W. de Groot ◽  
...  
Keyword(s):  
Cohort Study ◽  
The Netherlands ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Trauma Surgery ◽  
Trauma Centre ◽  
Trauma Severity ◽  
Number Of Patients ◽  
The Impact ◽  
Level 2

ObjectivesTo determine the impact of the first lockdown in the Netherlands’ measures during the COVID-19 pandemic on the number and type of trauma-related injuries presenting to the emergency department (ED).DesignA single-centre retrospective cohort study.SettingA level 2 trauma centre in Breda, The Netherlands.ParticipantsAll patients with trauma seen at the ED between 11 March and 10 May 2020 (the first Dutch lockdown period) were included in this study. Comparable groups were generated for 2019 and 2018.Main outcome measuresPrimary outcomes were the total number of patients with trauma admitted to the ED and the trauma mechanism. Secondary outcomes were triage categories, time of ED visit, trauma severity (Injury Severity Score (ISS) >12), anatomical region of injury and treatment.ResultsA total of 4674 patients were included in this study. During the first months of the COVID-19 pandemic, there was a decrease of 32% in traumatic injuries at the ED (n=1182) compared with the previous years 2019 (n=1717) and 2018 (n=1775) (p<0.001). Sports-related injuries decreased most during the lockdown (n=164) compared with 2019 (n=386) and 2018 (n=367) (p<0.001). We observed more frequent injuries due to a fall from standing height (p<0.001) and work-related injuries (p<0.05). The mean age was significantly higher (mean 48 years vs 42 and 43 years). There was no difference in anatomical place of injury or ISS >12. The amount of patients admitted for emergency surgery was significantly higher (14.6% vs 9.4%; 8.6%, p<0.001). Seven patients (0.6%) tested positive for COVID-19.ConclusionsMeasures taken in the COVID-19 outbreak result in a predictable decrease in the total number of patients with trauma, especially sports-related trauma. Although the trauma burden on the emergency room appears to be lower, more people have been admitted for trauma surgery, possibly due to increased throughput in the operating theatres.

scholarly journals Turning green: the impact of changing to more eco-friendly respiratory healthcare. A carbon and cost analysis of Dutch prescription data.

2021 ◽  
Author(s):  
Pieter ten Have ◽  
Peter van Hal ◽  
Iris Wichers ◽  
Johan Kooistra ◽  
Paul Hagedoorn ◽  
...  
Keyword(s):  
The Netherlands ◽  
Chronic Obstructive ◽  
Prescription Data ◽  
Obstructive Pulmonary Disease ◽  
Potential Reduction ◽  
Defined Daily Doses ◽  
Number Of Patients ◽  
Metered Dose ◽  
Annual Reduction ◽  
The Impact

Objectives Dry powder inhalers (DPIs) have a substantially lower global warming potential than pressurized metered-dose inhalers (MDIs). To help mitigate climate change, we assessed the potential reduction in CO2-equivalents when replacing MDIs by DPIs in the Netherlands, and estimated the associated cost. Design We performed a four-step analysis based on data from two national databases of two independent governmental bodies (Dutch National Healthcare Institute and the Dutch Healthcare Authority). First, we calculated the number of patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma that were using inhalation medication (2020). Second, we calculated the number and total of daily defined doses of MDIs, DPIs, and soft mist inhalers and the number of spacers per patients, dispensed by non-hospital based pharmacies in 2020. Third, we estimated the potential reduction in CO2-equivalents (eq.) if all eligible patients (≥7 years old; COPD with ≤exacerbation per year) would switch from using MDIs to using DPIs as eco-friendly alternatives. Fourth, we performed a cost-effectiveness analysis. Results In 2020, 1.4 million patients used inhalers for COPD or asthma treatment. A total of 460 million defined daily doses (DDDs) from inhalers were dispensed, of which, after the exclusion of nebulisers, 50.4% were from MDIs. We estimated that this use could be reduced by 70% leading to annual reduction in emissions of 77 - 84 million kg CO2eq. saving at best EUR 49.8 million annually. Conclusions In the Netherlands, substitution of MDIs to DPIs for eligible patients is theoretically safe and in accordance with medical guidelines, while reducing emissions by 80 million kg.CO2eq. on average and saving at best EUR 49.8 million per year. This study confirms the potential climate and economic benefit of delivering eco-friendlier respiratory care.

scholarly journals Exploring the Burden of Inpatient Readmissions After Major Cancer Surgery

2015 ◽  
Vol 33 (5) ◽  
pp. 455-464 ◽  
Author(s):  
Karyn B. Stitzenberg ◽  
YunKyung Chang ◽  
Angela B. Smith ◽  
Matthew E. Nielsen
Keyword(s):  
Length Of Stay ◽  
Negative Binomial ◽  
High Volume ◽  
Cancer Surgery ◽  
Travel Distance ◽  
Tumor Type ◽  
Readmission Rates ◽  
Term Survival ◽  
Index Hospital ◽  
Travel Distances

Purpose Travel distances to care have increased substantially with centralization of complex cancer procedures at high-volume centers. We hypothesize that longer travel distances are associated with higher rates of postoperative readmission and poorer outcomes. Methods SEER-Medicare patients with bladder, lung, pancreas, or esophagus cancer who were diagnosed in 2001 to 2007 and underwent extirpative surgery were included. Readmission rates and survival were calculated using Kaplan-Meier functions. Multivariable negative binomial models were used to examine factors associated with readmission. Results Four thousand nine hundred forty cystectomies, 1,573 esophagectomies, 20,362 lung resections, and 2,844 pancreatectomies were included. Thirty- and 90-day readmission rates ranged from 13% to 29% and 23% to 43%, respectively, based on tumor type. Predictors of readmission were discharge to somewhere other than home, longer length of stay, comorbidities, higher stage at diagnosis, and longer travel distance (P < .001 for each). Patients who lived farther from the index hospital also had increased emergency room visits and were more likely to be readmitted to a hospital other than the index hospital (P < .001). Of readmitted patients, 31.9% were readmitted more than once. Long-term survival was worse and costs of care higher for patients who were readmitted (P < .001 for all). Conclusion The burden of readmissions after major cancer surgery is high, resulting in substantially poorer patient outcomes and higher costs. Risk of readmission was most strongly associated with length of stay and discharge destination. Travel distance also has an impact on patterns of readmission. Interventions targeted at higher risk individuals could potentially decrease the population burden of readmissions after major cancer surgery.

Impact of geography and travel distance on outcomes in epithelial ovarian cancer: a national cancer database analysis

2020 ◽  
pp. ijgc-2020-001807
Author(s):  
Ava Daruvala ◽  
F Lee Lucas ◽  
Jesse Sammon ◽  
Christopher Darus ◽  
Leslie Bradford
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Healthcare Delivery ◽  
High Volume ◽  
Cox Proportional Hazards ◽  
Travel Distance ◽  
Cancer Center ◽  
National Cancer Database ◽  
Significant Difference ◽  
The Impact

BackgroundAs ovarian cancer treatment shifts to provide more complex aspects of care at high-volume centers, almost a quarter of patients, many of whom reside in rural counties, will not have access to those centers or receive guideline-based care.ObjectiveTo explore the association between proximity of residential zip code to a high-volume cancer center with mortality and survival for patients with ovarian cancer.MethodsThe National Cancer Database was queried for cases of newly diagnosed ovarian cancer between January 2004 and December 2015. Our predictor of interest was distance traveled for treatment. Our primary outcomes were 30-day mortality, 90-day mortality, and overall survival. The effect of treatment on survival was analyzed with the Kaplan-Meier method. Multiple logistic regression for binary outcomes and Cox proportional hazards regression for overall survival were used to assess the effect of distance on outcome, controlling for potential confounding variables.ResultsA total of 115 540 patients were included. There was no statistically significant difference in 30- or 90-day mortality among any of the travel distance categories. A statistically significant decrease in 30-day re-admission was found among patients who lived further away from the treating facility. A total of 105 529 patients were available for survival analysis, and survival curves significantly differed between distance strata (p<0.0001). The adjusted regression models demonstrated increased long-term mortality in patients who lived farther away from the treating facility after controlling for potential confounding.ConclusionAlthough 30- and 90-day mortality do not differ by travel distance, worse survival is observed among women living >50 miles from a high-volume treatment facility. With a national policy shift toward centralization of complex care, a better understanding of the impact of distance on survival in patients with ovarian cancer is crucial. Our findings inform the practice of healthcare delivery, especially in rural settings.

The impact of COVID-19 on surgical volume and surgical training at a high-volume pelvic oncology centre

2021 ◽  
pp. 039156032110628
Author(s):  
Wissam Abou-Chedid ◽  
Gregory J Nason ◽  
Andrew T Evans ◽  
Kohei Yamada ◽  
Dimitrios Moschonas ◽  
...  
Keyword(s):  
High Volume ◽  
Annual Number ◽  
Clinical Activity ◽  
Prostate Brachytherapy ◽  
Robotic Assisted ◽  
Period 2 ◽  
Urological Oncology ◽  
Number Of Patients ◽  
Oncology Centre ◽  
The Impact

Introduction: The coronavirus (COVID-19) pandemic has overwhelmed most health services. As a result, many surgeries have been deferred and diagnoses delayed. The aim of this study was to assess the effect of the COVID-19 pandemic at a high-volume pelvic oncology centre. Methods: A retrospective review was performed of clinical activity from 2017 to 2020. We compared caseload for index procedures 2017–2019 (period 1) versus 2020 (period 2) to see the effect of the COVID pandemic. We then compared the activity during the first lockdown (March 23rd) to the rest of the year when we increased our theatre access by utilising a ‘clean’ site. Results: The average annual number of robotic assisted radical cystectomy (RARC) and robotic assisted radical prostatectomy (RARP) performed during period 1 was 82 and 352 respectively. This reduced to 68 (17.1% reduction) and 262 (25.6% reduction) during period 2. The number of patients who underwent prostate brachytherapy decreased from 308 to 243 (21% reduction). The number of prostate biopsies decreased from 420 to 234 (44.3% reduction). The number of radical orchidectomies decreased from 18 to 11 (39% reduction). The mean number of RARC and RARP per month during period 2 was 5.5 and 22. This decreased to 4 and 9 per month during the first national lockdown but was maintained thereafter despite two further lockdowns. Conclusion: There has been a substantial decrease in urological oncology caseload during the COVID pandemic. The use of alternate pathways such as ‘clean’ sites can ensure continuity of care for cancer surgery and training needs.

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