Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2015

Open Access 01-12-2015 | Research article

Variation in guideline adherence in non-Hodgkin’s lymphoma care: impact of patient and hospital characteristics

Authors: Jozette J.C. Stienen, Rosella P.M.G. Hermens, Lianne Wennekes, Saskia A.M. van de Schans, Richard W.M. van der Maazen, Helena M. Dekker, Janine Liefers, Johan H.J.M. van Krieken, Nicole M.A. Blijlevens, Petronella B. Ottevanger, On behalf of the PEARL study group

Published in: BMC Cancer | Issue 1/2015

Login to get access

Abstract

Background

The objective of this observational study was to assess the influence of patient, tumor, professional and hospital related characteristics on hospital variation concerning guideline adherence in non-Hodgkin’s lymphoma (NHL) care.

Methods

Validated, guideline-based quality indicators (QIs) were used as a tool to assess guideline adherence for NHL care. Multilevel logistic regression analyses were used to calculate variation between hospitals and to identify characteristics explaining this variation. Data for the QIs regarding diagnostics, therapy, follow-up and organization of care, together with patient, tumor and professional related characteristics were retrospectively collected from medical records; hospital characteristics were derived from questionnaires and publically available data.

Results

Data of 423 patients diagnosed with NHL between October 2010 and December 2011 were analyzed. Guideline adherence, as measured with the QIs, varied considerably between the 19 hospitals: >20 % variation was identified in all 20 QIs and high variation between the hospitals (>50 %) was seen in 12 QIs, most frequently in the treatment and follow-up domain.
Hospital variation in NHL care was associated more than once with the characteristics age, extranodal involvement, multidisciplinary consultation, tumor type, tumor aggressiveness, LDH level, therapy used, hospital region and availability of a PET-scanner.

Conclusion

Fifteen characteristics identified at the patient level and at the hospital level could partly explain hospital variation in guideline adherence for NHL care. Particularly age was an important determinant: elderly were less likely to receive care as measured in the QIs. The identification of determinants can be used to improve the quality of NHL care, for example, for standardizing multidisciplinary consultations in daily practice.
Literature
1.
Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol. 2012;13(8):790–801.CrossRefPubMed
2.
3.
4.
Sant M, Minicozzi P, Mounier M, Anderson LA, Brenner H, Holleczek B, et al. Survival for haematological malignancies in Europe between 1997 and 2008 by region and age: results of EUROCARE-5, a population-based study. Lancet Oncol. 2014;15(9):931–42.CrossRefPubMed
5.
Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, et al. SEER Cancer Statistics Review 1975–2011. In: National Cancer Institute. Bethesda, MD: Table 19.29: Non-Hodgkin Lymphoma Subtypes, 15-Year Relative Survival by Age at Diagnosis, 2004–2010; 2014.
6.
IOM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001.
7.
Berrios-Rivera JP, Fang S, Cabanillas ME, Cabanillas F, Lu H, Du XL. Variations in chemotherapy and radiation therapy in a large nationwide and community-based cohort of elderly patients with non-Hodgkin lymphoma. Am J Clin Oncol. 2007;30(2):163–71.CrossRefPubMed
8.
Friedberg JW, Taylor MD, Cerhan JR, Flowers CR, Dillon H, Farber CM, et al. Follicular lymphoma in the United States: first report of the national LymphoCare study. J Clin Oncol. 2009;27(8):1202–8.CrossRefPubMedPubMedCentral
9.
Wennekes L, Ottevanger PB, Raemaekers JM, Schouten HC, de Kok MW, Punt CJ, et al. Development and measurement of guideline-based indicators for patients with non-Hodgkin’s lymphoma. J Clin Oncol. 2011;29(11):1436–44.CrossRefPubMed
10.
Lawrence M, Olesen F. Indicators of quality in health care. Eur J Gen Pract. 1997;3:103–8.CrossRef
11.
Boslooper K, Kibbelaar R, Storm H, Veeger NJ, Hovenga S, Woolthuis G, et al. Treatment with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone is beneficial but toxic in very elderly patients with diffuse large B-cell lymphoma: a population-based cohort study on treatment, toxicity and outcome. Leuk Lymphoma. 2014;55:526–32.CrossRefPubMed
12.
van de Schans SA, Wymenga AN, van Spronsen DJ, Schouten HC, Coebergh JW, Janssen-Heijnen ML. Two sides of the medallion: poor treatment tolerance but better survival by standard chemotherapy in elderly patients with advanced-stage diffuse large B-cell lymphoma. Ann Oncol. 2012;23(5):1280–6.CrossRefPubMed
13.
Hermens RP, Haagen EC, Nelen WL, Tepe EM, Akkermans R, Kremer JA, et al. Patient and hospital characteristics associated with variation in guideline adherence in intrauterine insemination care. Int J Qual Health Care. 2011;23(5):574–82.CrossRefPubMed
14.
Peters-Klimm F, Laux G, Campbell S, Muller-Tasch T, Lossnitzer N, Schultz JH, et al. Physician and patient predictors of evidence-based prescribing in heart failure: a multilevel study. PLoS One. 2012;7(2):e31082.CrossRefPubMedPubMedCentral
15.
Reeves MJ, Gargano J, Maier KS, Broderick JP, Frankel M, LaBresh KA, et al. Patient-level and hospital-level determinants of the quality of acute stroke care: a multilevel modeling approach. Stroke. 2010;41(12):2924–31.CrossRefPubMed
16.
Kasje WN, Denig P, Stewart RE, de Graeff PA, Haaijer-Ruskamp FM. Physician, organisational and patient characteristics explaining the use of angiotensin converting enzyme inhibitors in heart failure treatment: a multilevel study. Eur J Clin Pharmacol. 2005;61(2):145–51.CrossRefPubMed
17.
McCavit TL, Lin H, Zhang S, Ahn C, Quinn CT, Flores G. Hospital volume, hospital teaching status, patient socioeconomic status, and outcomes in patients hospitalized with sickle cell disease. Am J Hematol. 2011;86(4):377–80.CrossRefPubMedPubMedCentral
18.
Ouwens MM, Hermens RR, Termeer RA, Vonk-Okhuijsen SY, Tjan-Heijnen VC, Verhagen AF, et al. Quality of integrated care for patients with nonsmall cell lung cancer: variations and determinants of care. Cancer. 2007;110(8):1782–90.CrossRefPubMed
19.
Trinh QD, Sammon J, Jhaveri J, Sun M, Ghani KR, Schmitges J, et al. Variations in the quality of care at radical prostatectomy. Ther Adv Urol. 2012;4(2):61–75.CrossRefPubMedPubMedCentral
20.
Stienen JJ, Ottevanger PB, Wennekes L, van de Schans SA, Dekker HM, van der Maazen RW, et al. Trends in quality of non-Hodgkin’s lymphoma care: is it getting better? Annals of hematology. 2015;94(7):1195–203.CrossRefPubMedPubMedCentral
21.
Stienen JJ, Hermens RP, Wennekes L, van de Schans SA, Dekker HM, Blijlevens NM, et al. Improvement of hospital care for patients with non-Hodgkin’s lymphoma: protocol for a cluster randomized controlled trial (PEARL study). IS. 2013;8:77.PubMedPubMedCentral
22.
Mourad SM, Nelen WL, Hermens RP, Bancsi LF, Braat DD, Zielhuis GA, et al. Variation in subfertility care measured by guideline-based performance indicators. Hum Reprod. 2008;23(11):2493–500.CrossRefPubMed
23.
Ouwens MM, Marres HA, Hermens RR, Hulscher MM, van den Hoogen FJ, Grol RP, et al. Quality of integrated care for patients with head and neck cancer: Development and measurement of clinical indicators. Head Neck. 2007;29(4):378–86.CrossRefPubMed
24.
Smit M, Chan KL, Middeldorp JM, van Roosmalen J. Postpartum haemorrhage in midwifery care in the Netherlands: validation of quality indicators for midwifery guidelines. BMC Pregnancy Childbirth. 2014;14(1):397.CrossRefPubMedPubMedCentral
25.
Lin TL, Kuo MC, Shih LY, Dunn P, Wang PN, Wu JH, et al. The impact of age, Charlson comorbidity index, and performance status on treatment of elderly patients with diffuse large B cell lymphoma. Ann Hematol. 2012;91(9):1383–91.CrossRefPubMed
26.
Leyland AH, Groenewegen PP. Multilevel modelling and public health policy. Scand J Public Health. 2003;31(4):267–74.CrossRefPubMed
27.
Weeks JC, Uno H, Taback N, Ting G, Cronin A, D’Amico TA, et al. Interinstitutional variation in management decisions for treatment of 4 common types of cancer: A multi-institutional cohort study. Ann Intern Med. 2014;161(1):20–30.CrossRefPubMedPubMedCentral
28.
Elferink MA, Wouters MW, Krijnen P, Lemmens VE, Jansen-Landheer ML, van de Velde CJ, et al. Disparities in quality of care for colon cancer between hospitals in the Netherlands. Eur J Surg Oncol. 2010;36 Suppl 1:S64–73.CrossRefPubMed
29.
Mathoulin-Pelissier S, Becouarn Y, Belleannee G, Pinon E, Jaffre A, Coureau G, et al. Regional Aquitaine Group for Colorectal cancer G: Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors. BMC Cancer. 2012;12:297.CrossRefPubMedPubMedCentral
30.
McCahill LE, Single RM, Aiello Bowles EJ, Feigelson HS, James TA, Barney T, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307(5):467–75.CrossRefPubMed
31.
van Leersum NJ, Snijders HS, Wouters MW, Henneman D, Marijnen CA, Rutten HR, et al. Dutch Surgical Colorectal Cancer Audit G: Evaluating national practice of preoperative radiotherapy for rectal cancer based on clinical auditing. Eur J Surg Oncol. 2013;39(9):1000–6.CrossRefPubMed
32.
Etzioni DA, Young-Fadok TM, Cima RR, Wasif N, Madoff RD, Naessens JM, et al. Patient survival after surgical treatment of rectal cancer: impact of surgeon and hospital characteristics. Cancer. 2014;120(16):2472–81.CrossRefPubMed
33.
Schroeck FR, Kaufman SR, Jacobs BL, Skolarus TA, Hollingsworth JM, Shahinian VB, et al. Regional variation in quality of prostate cancer care. J Urol. 2014;191(4):957–62.CrossRefPubMed
34.
Sacerdote C, Baldi I, Bertetto O, Dicuonzo D, Farina E, Pagano E, et al. Hospital factors and patient characteristics in the treatment of colorectal cancer: a population based study. BMC Public Health. 2012;12:775.CrossRefPubMedPubMedCentral
35.
Trebouet A, Marchand T, Lemal R, Gyan E, Broussais-Guillaumot F, Guillermin Y, et al. Lymphoma occurring in patients over 90 years of age: characteristics, outcomes, and prognostic factors. A retrospective analysis of 234 cases from the LYSA. Ann Oncol. 2013;24(10):2612–8.CrossRefPubMed
36.
Aparicio T, Navazesh A, Boutron I, Bouarioua N, Chosidow D, Mion M, et al. Half of elderly patients routinely treated for colorectal cancer receive a sub-standard treatment. Crit Rev Oncol Hematol. 2009;71(3):249–57.CrossRefPubMed
37.
Kuper-Hommel MJ, van de Schans SA, Vreugdenhil G, van Krieken JH, Coebergh JW. Undertreatment of patients with localized extranodal compared with nodal diffuse large B-cell lymphoma. Leuk Lymphoma. 2013;54(8):1698–705.CrossRefPubMed
38.
Kuper-Hommel MJ, van de Schans SA, Vreugdenhil G, van Krieken JH, Coebergh JW. Trends in incidence, therapy and outcome of localized nodal and extranodal marginal zone lymphomas: declining incidence and inferior outcome for gastrointestinal sites. Leuk Lymphoma. 2013;54(9):1891–7.CrossRefPubMed
Metadata
Title
Variation in guideline adherence in non-Hodgkin’s lymphoma care: impact of patient and hospital characteristics
Authors
Jozette J.C. Stienen
Rosella P.M.G. Hermens
Lianne Wennekes
Saskia A.M. van de Schans
Richard W.M. van der Maazen
Helena M. Dekker
Janine Liefers
Johan H.J.M. van Krieken
Nicole M.A. Blijlevens
Petronella B. Ottevanger
On behalf of the PEARL study group
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2015
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-015-1547-8

Other articles of this Issue 1/2015

BMC Cancer 1/2015 Go to the issue

Study protocol

Bevacizumab and Combination Chemotherapy in rectal cancer Until Surgery (BACCHUS): a phase II, multicentre, open-label, randomised study of neoadjuvant chemotherapy alone in patients with high-risk cancer of the rectum

Research article

Negative effect of cyclin D1 overexpression on recurrence-free survival in stage II-IIIA lung adenocarcinoma and its expression modulation by vorinostat in vitro

Research article

TKTL1 expression in human malign and benign cell lines

Research article

Clinical and pathological significance of ROS1 expression in intrahepatic cholangiocarcinoma

Research article

Transcriptional expression of 8 genes predicts pathological response to first-line docetaxel + trastuzumab-based neoadjuvant chemotherapy

Research article

HIV testing and burden of HIV infection in black cancer patients in Johannesburg, South Africa: a cross-sectional study
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits