Leiden University Scholarly Publications

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Hoeijmakers, F. (2025)

Evaluating lung cancer care in the Netherlands: staging, treatment and surgical quality assurance

Doctoral Thesis
This thesis evaluates lung cancer care in the Netherlands, with a strong focus on between-hospital variation, aiming to improve outcomes and provide insight into care processes.
Data from the Dutch Lung Cancer Audit (DLCA) were compared with Danish audit data, revealing similar mortality and staging accuracy, though differences in complication rates proved difficult to interpret due to inconsistent definitions and data collection methods. The thesis also evaluated the data collection framework of the Dutch Institute for Clinical Auditing (DICA), emphasizing its role in ensuring data quality.
Further analysis focused on staging mediastinoscopy, revealing acceptable overall rates of unforeseen N2 disease but notable variation between hospitals. Guideline adherence was linked to improved outcomes. Multidisciplinary team (MDT) decision-making was also assessed, showing inconsistencies in staging and treatment recommendations—likely rapid innovations and...Show moreThis thesis evaluates lung cancer care in the Netherlands, with a strong focus on between-hospital variation, aiming to improve outcomes and provide insight into care processes.
Data from the Dutch Lung Cancer Audit (DLCA) were compared with Danish audit data, revealing similar mortality and staging accuracy, though differences in complication rates proved difficult to interpret due to inconsistent definitions and data collection methods. The thesis also evaluated the data collection framework of the Dutch Institute for Clinical Auditing (DICA), emphasizing its role in ensuring data quality.
Further analysis focused on staging mediastinoscopy, revealing acceptable overall rates of unforeseen N2 disease but notable variation between hospitals. Guideline adherence was linked to improved outcomes. Multidisciplinary team (MDT) decision-making was also assessed, showing inconsistencies in staging and treatment recommendations—likely rapid innovations and outdated guidelines play a role. The thesis questions the overreliance on TNM staging and advocates for a more extensive, patient-tailored approach that includes biological and clinical factors.
Perioperative care was assessed using hospital length of stay, revealing substantial variation, suggesting room for improvement via standardization. Persistent air leak (PAL), a common complication, also varied widely, with better outcomes linked to specific chest tube management practices. Overall, the thesis demonstrates how clinical auditing and data feedback can drive improvements in lung cancer care.Show less
Lung cancer
Staging
Between-hospital variation
Clinical auditing
Quality of care
All authors
Hoeijmakers, F.
Supervisor
Tollenaar, R.A.E.M.
Co-supervisor
Schreurs, W.H.; Heineman, D.J.
Committee
Wouters, M.W.J.M.; Stiggelbout, A.M.; Senan, S.; Verhagen, A.F.
Qualification
Doctor (dr.)
Awarding Institution
Leiden University Medical Center (LUMC), Leiden University
Date
2025-05-08
ISBN (print)
9789465221588

Funding

Sponsorship
Dutch Institute for Clinical Auditing (DICA); SOLV Advocaten Amsterdam ; ABN AMRO