Treatment Patterns and Differences in Survival of Non-Small Cell Lung Cancer Patients Between Academic and Non-Academic Hospitals in the Netherlands

van der Linden, N., Bongers, M. L., Coupe, V. M. H., Smit, E. F., Groen, H. J. M., Welling, A., Schramel, F. M. N. H. & Uyl-de Groot, C. A., Sep-2017, In : Clinical lung cancer. 18, 5, p. e341-e347 7 p.

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  • Treatment Patterns and Differences in Survival of Non-Small Cell Lung Cancer Patients Between Academic and Non-Academic Hospitals in the Netherlands

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  • Naomi van der Linden
  • Mathilda L. Bongers
  • Veerle M. H. Coupe
  • Egbert F. Smit
  • Harry J. M. Groen
  • Alle Welling
  • Franz M. N. H. Schramel
  • Carin A. Uyl-de Groot

Non-small cell lung cancer (NSCLC) survival is compared between patients treated in all academic (n [1289) versus all non-academic (n = 12,698) Dutch hospitals, using Kaplan-Meier estimates and a Cox proportional hazards model. For 1009 patients, treatment patterns are described. Diagnosis in an academic hospital is associated with decreased mortality. Possibilities for improvement of NSCLC care are suggested.

Background: The aims of this study are to analyze differences in survival between academic and non-academic hospitals and to provide insight into treatment patterns for non-small cell lung cancer (NSCLC). Results show the state of NSCLC survival and care in the Netherlands. 

Methods: The Netherlands Cancer Registry provided data on NSCLC survival for all Dutch hospitals. We used the Kaplan-Meier estimate to calculate median survival time by hospital type and a Cox proportional hazards model to estimate the relative risk of mortality (expressed as hazard ratios) for patients diagnosed in academic versus non-academic hospitals, with adjustment for age, gender, and tumor histology, and stratifying for disease stage. Data on treatment patterns in Dutch hospitals was obtained from 4 hospitals (2 academic, 2 non-academic). A random sample of patients diagnosed with NSCLC from January 2009 until January 2011 was identified through hospital databases. Data was obtained on patient characteristics, tumor characteristics, and treatments. 

Results: The Cox proportional hazards model shows a significantly decreased hazard ratio of mortality for patients diagnosed in academic hospitals, as opposed to patients diagnosed in non-academic hospitals. This is specifically true for primary radiotherapy patients and patients who receive systemic treatment for non-metastasized NSCLC. 

Conclusion: Patients diagnosed in academic hospitals have better median overall survival than patients diagnosed in non-academic hospitals, especially for patients treated with radiotherapy, systemic treatment, or combinations. This difference may be caused by residual confounding since the estimates were not adjusted for performance status. A wide variety of surgical, radiotherapeutic, and systemic treatments is prescribed.

Original languageEnglish
Pages (from-to)e341-e347
Number of pages7
JournalClinical lung cancer
Issue number5
Publication statusPublished - Sep-2017


  • Academic medical centers, Cancer registry, General hospitals, Mortality, Therapy

ID: 49365420