Background: The potential benefit of surgery of the primary tumour in patients with asymptomatic metastatic colorectal cancer is debated. This EURECCA international comparison analyses treatment... Show moreBackground: The potential benefit of surgery of the primary tumour in patients with asymptomatic metastatic colorectal cancer is debated. This EURECCA international comparison analyses treatment strategies and overall survival in the Netherlands and Norway in patients with incurable metastatic colorectal cancer.Methods: National cohorts (2007-2013) from the Netherlands and Norway including all patients with synchronous metastatic colorectal cancer were compared on treatment strategy and overall survival. Using country as an instrumental variable, we assessed the effect of different treatment strategies on mortality in the first year.Results: Of 21,196 patients (16,144 Dutch and 5052 Norwegian), 38.6% Dutch and 51.5% (p < 0.001) Norwegian patients underwent resection of the primary tumour. In the Netherlands, 58.2% received chemotherapy compared with 21.4% in Norway. Radiotherapy was given in 9.5% of Dutch patients and 7.2% of Norwegian patients. Using the Netherlands as reference, the adjusted HR for overall survival was 0.96 (95% CI 0.93-0.99; p = 0.024). Instrumental variable analysis showed an adjusted OR of 1.00 (95% CI 0.99-1.02; p = 0.741).Conclusions: Treatment strategies varied significantly between the Netherlands and Norway, with more surgery and less radiotherapy in Norway. Adjusted overall survival was better in Norway for all patients and patients <75 years, but not for patients >= 75 years. Instrumental variable analysis showed no benefit in one-year mortality for a treatment strategy with a higher proportion of surgery and a lower proportion of radiotherapy. Our findings emphasise the need for further research to select patients with incurable metastatic colorectal cancer for different treatment options. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved. Show less
Large variation between hospitals and pathology laboratories was demonstrated in adherence to the guidelines. This is associated with type and volume of hospitals and pathology laboratories.... Show moreLarge variation between hospitals and pathology laboratories was demonstrated in adherence to the guidelines. This is associated with type and volume of hospitals and pathology laboratories. However, not all variation could be explained by these characteristics. The aim of this thesis was to identify factors influencing quality of care by investigating the variation in guidelines adherence of patients with colon and rectal cancer in the Netherlands. Considerable variation in lymph node evaluation between hospitals and pathology laboratories was revealed leading to suboptimal staging and potentially inaccurate treatment plans. Furthermore, large differences between hospitals were found in treatment according tot the guidelines. Based on the results of this thesis, it can be conclude that a part of the variation is associated with type and volume of hospitals and pathology laboratories. However, the large differences between individual hospitals suggests that these characteristics do not account for all variation. Therefore, further research is necessary to identify best practices and analyse factors which influence quality of care and outcome. Show less
