Technical efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals

Background Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors. Methods Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians’ judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores. Results Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001). Conclusion This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care.

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The Care Pathway Delays of Cervical Cancer Patient in Morocco

Obstetrics and Gynecology International ◽

10.1155/2020/8796570 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Hind Mimouni ◽

Khalid Hassouni ◽

Boujemaa El Marnissi ◽

Bouchra Haddou Rahou ◽

Leila Alaoui ◽

...

Keyword(s):

Cervical Cancer ◽

Health System ◽

Cancer Care ◽

Care Pathway ◽

Diagnostic Delay ◽

Patient Delay ◽

University Hospital ◽

Cervical Cancer Patient ◽

Diagnosis Delay ◽

Time Intervals

Introduction. The aim of this study is to document time intervals in cervical cancer care pathways, from symptom onset to disease detection and start of treatment, and evaluate how clinical, sociodemographic, and treatment factors influence delays throughout a patient’s clinical pathway. Methods. A retrospective study was conducted at the FEZ Oncology Hospital of the Hassan II University Hospital Center in Morocco. Results. 190 medical records of cervical cancer patients were collected. The dominant age group was 35–44, the median patient delay (PD) was 6 days, the median healthcare provider’s delay (HCP) was 21 days, the median referral delay (RD) was 17 days, the median diagnostic delay (DD) was 9.5 days, the median total diagnostic delay (TDD) was 16 days, the median treatment delay (TD) was 67 days, and the median health system interval (HSI) was 92 days. Multivariate analysis revealed that age was associated with the patient delay, the healthcare provider’s delay, the diagnosis delay, and the health system interval. The diagnosis year (the year in which the patient was diagnosed (either before 2012 or during 2012 as well as the other study years (from 2013 to 2017))), all investigations done prior to admission to the oncology hospital, and the age of first sexual activity were significantly associated with healthcare provider’s delay. Conclusion. The integration of a model and standard care pathway into the Moroccan health system is essential in order to unify cervical cancer care in the country.

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Colorectal cancer characteristics and outcomes in patients less than age 50: A comparison of an urban university hospital with the NCI SEER database.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.3621 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 3621-3621 ◽

Cited By ~ 1

Author(s):

Edith P. Mitchell ◽

Allan Topham ◽

Pramila R. Anne ◽

Scott Goldstein ◽

Gerald Isenberg ◽

...

Keyword(s):

Colorectal Cancer ◽

Older Patients ◽

University Hospital ◽

Data Sets ◽

Seer Database ◽

Pathological Features ◽

Younger Patients ◽

The Third ◽

Colorectal Cancer Patients ◽

Better Than

3621 Background: Cancer of the colon and rectum is the third most commonly occurring cancer, as well as the third leading cause of cancer deaths in American men and women. Colorectal cancer in younger patients is believed to have worse pathological features and prognosis than in older patients. The objective of this study was to assess pathological features and outcomes of CRC in patients less than age 50 using an institutional sample and comparing to the Surveillance, Epidemiology and End Results (SEER) database. Methods: Included in the study were a total of 4595 cases from the Tumor Registry at Thomas Jefferson University Hospital (TJUH) over a twenty year period from 1988 through 2007 and 290,338 cases from the Surveillance, Epidemiology and End Results (SEER) database from 1988 through 2004. Patients less than age 50 were compared to those age 50 and older. Results: Patients under age 50 with CRC presented with more advanced stage tumors in both data sets (<0.0001) , and had more poorly differentiated tumors than older patients (PTJUH=0.02754; PSEER<0.0001). Patients under 50 also had more mucinous/signet ring cell tumors with 12 percent to 8.1 percent in the TJUH data (p=0.002916) and 13.2 percent to 10.3 percent in the SEER data (p<0.0001), with younger males having the highest prevalence in both data sets. Younger patients had fewer proximal tumors than patients 50 and over, and a higher proportion of rectal tumors (p<0.001). Patients under age 50 were more likely to have positive nodes at all stages (PSEER <0.0001) relative to 50 and over, as well as more likely to develop peritoneal metastases (PTJUH=0.3507),, but less likely to have lung metastases PTJUH=0.05249) than older pts. Despite their poor pathologic features, patients under age 50 had better than or equal survival to those 50 and older. Conclusions: Colorectal cancer patients under age 50 presented with worse histological characteristics and metastasized much sooner, yet the younger patients had better than or equal survival to those ages 50 and older. Ongoing studies will assess differences in treatment and molecular features between younger and older colorectal cancer patients.

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