Hospital variation in referral for primary radiotherapy in South Netherlands, 1988–1999

• Published in: European journal of cancer (1990) Vol. 41; no. 17; pp. 2722 - 2727
• Main Authors: Vulto, J.C.M., Louwman, W.J., Poortmans, P.M.P., Coebergh, J.W.W.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.11.2005; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Female; Health Facility Size - statistics & numerical data; Humans; Inter-hospital variation; Male; Medical sciences; Middle Aged; Neoplasms - radiotherapy; Netherlands; Pharmacology. Drug treatments; Population-based; Radiotherapy; Referral and Consultation - statistics & numerical data; Referral and Consultation - trends; Referral rates; Regression Analysis; Tumors; Netherlands; Europe; Population-based; Inter-hospital variation; Radiotherapy; Referral rates; Human; Cancerology; Treatment; Primary; Pharmacology; Hospital
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2005.04.048

In this study, we have assessed whether referral for primary radiotherapy varied according to hospital size in a region with 1 million inhabitants served by community hospitals. We studied 20 178 patients diagnosed with breast, non-small cell lung, prostate, rectal, or endometrial cancer between 1988 and 1999. We used logistic regression analysis, adjusted for age, stage and period of diagnosis. Medium-sized and small hospitals referred breast cancer patients more often (OR = 2.2, 95%CI: 2.0–2.5, OR = 1.2, 95%CI: 1.1–1.4, respectively), and patients with prostate cancer less often (OR = 0.7 (0.5–0.8) and 0.7 (0.6–0.9), respectively). Referral rates for patients with non-small cell lung and rectal cancer showed minor differences according to hospital size, referral for endometrial cancer was somewhat higher for patients from medium-sized hospitals (OR = 1.5 (1.0–2.1)). Time trends in variation were shown, but differences according to hospital size only decreased over time for rectal cancer. Despite multidisciplinary oncology meetings and treatment guidelines there were large variations in rates of referral for radiotherapy.