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Survival analysis of cancer patients in Portugal following the reference centre model implementation

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Abstract

Cancer has affected around eighteen million people all over the world in 2018. In Portugal, cancer was diagnosed in sixty thousand individuals during 2018, being the second leading cause of death (one in every four deaths). Following the European Directive 2011/24/EU, the Portuguese Health System has been recognizing oncology Reference Centres (RCs), which are focused on delivering best-in-class treatment for cancer patients. This paper performs a survival analysis of cancer patients in Portugal, having hospital episodes with discharge date after the official recognition, in 2016, of the first RCs for hepatobiliary, pancreatic, sarcomas and oesophageal cancer. The aim is to assess the impact of RCs on the survival probability of these patients. For each cancer type, survival curves are estimated using the Kaplan–Meier methodology, and hazard ratios are estimated for different covariates, using multivariate Extended Cox models. The results obtained support the implementation and encourage the further extension of the RC model for oncology in Portugal, as cancer patients treated in an oncology RC, overall, have a better survival probability when compared to patients who had no episode in an RC. These results are clearer for hepatobiliary and pancreatic cancer, but also visible for sarcomas and oesophageal cancer.

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References

  1. Direção-geral da Saúde: programa nacional para as doenças oncológicas, Lisbon (2017)

  2. Penedo, J.M., Carvalho, B.S., Pego, G.A., Pedroto, I.M., Diniz, J.A., Sampaio, M.S., Casella, P.M.: Reference centres—final report. (2014)

  3. Global cancer observatory—international agency for research on cancer: Portugal. (2019)

  4. Lopes, J.M., Gonçalves, F.R., Borges, M., Redondo, P., Laranja-Pontes, J.: The cost of cancer treatment in Portugal. eCancer (2017). https://doi.org/10.3332/ecancer.2017.765

    Article  Google Scholar 

  5. ACSS: Rede nacional de especialidade hospitalar e de referenciação de oncologia médica. (2016)

  6. European Commission: European Reference Networks—working for patients with rare, low-prevalence and complex diseases, Luxembourg (2017)

  7. Elrod, J.K., Fortenberry Jr., J.L.: Centers of excellence in healthcare institutions: what they are and how to assemble them. BMC Health Serv. Res. 17(Suppl 1), 425 (2017). https://doi.org/10.1186/s12913-017-2340-y

  8. Graf von der Schulenburg, J.M., Frank, M.: Rare is frequent and frequent is costly: rare diseases as a challenge for health care systems, https://link.springer.com/article/10.1007/s10198-014-0639-8, (2015)

  9. Kleinbaum, D.G., Klein, M.: Introduction to survival analysis—a self-learning text, 3rd edn. Springer-Verlag, New York (2012)

    Book  Google Scholar 

  10. Blay, J., Honoré, C., Stoeckle, E., Meeus, P., Jafari, M., Gouin, F., Anract, P., Ferron, G., Rochwerger, A., Ropars, M., Carrere, S., Marchal, F., Sirveaux, F., Di Marco, A., Le Nail, L.R., Guiramand, J., Vaz, G., Machiavello, J.-C., Marco, O., Causeret, S., Gimbergues, P., Fiorenza, F., Chaigneau, L., Guillemin, F., Guilloit, J.-M., Dujardin, F., Spano, J.-P., Ruzic, J.-C., Michot, A., Soibinet, P., Bompas, E., Chevreau, C., Duffaud, F., Rios, M., Perrin, C., Firmin, N., Bertucci, F., Le Pechoux, C., Le Loarer, F., Collard, O., Karanian-Philippe, M., Brahmi, M., Dufresne, A., Dupré, A., Ducimetière, F., Giraud, A., Pérol, D., Toulmonde, M., Ray-Coquard, I., Italiano, A., Le Cesne, A., Penel, N., Bonvalot, S.: Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann. Oncol. Off. J. Eur. Soc. Med. Oncol. 30, 1143–1153 (2019). https://doi.org/10.1093/annonc/mdz124

    Article  Google Scholar 

  11. Hoekstra, H.J., Haas, R.L.M., Verhoef, C., Suurmeijer, A.J.H., van Rijswijk, C.S.P., Bongers, B.G.H., van der Graaf, W.T., Ho, V.K.Y.: Adherence to guidelines for adult (non-GIST) soft tissue sarcoma in the Netherlands: a plea for dedicated sarcoma centers. Ann. Surg. Oncol. 24, 3279–3288 (2017). https://doi.org/10.1245/s10434-017-6003-3

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wahutu, M., Vesely, S.K., Campbell, J., Pate, A., Salvatore, A.L., Janitz, A.E.: Pancreatic cancer: a survival analysis study in Oklahoma. J. Okla. State Med. Assoc. 109, 391–398 (2016)

    PubMed  PubMed Central  Google Scholar 

  13. Stensrud, M.J., Hernán, M.A.: Why test for proportional hazards? JAMA 323(14), 1401–1402 (2020). https://doi.org/10.1001/jama.2020.1267

    Article  PubMed  Google Scholar 

  14. Therneau, T.M.: A package for survival analysis in R (2020). https://CRAN.R-project.org/package=survival

  15. Therneau, T., Crowson, C., Atkinson, E.: Using time dependent covariates and time dependent coefficients in the cox model. Survival Vignettes (2017)

  16. Seshadri, R.M., Besur, S., Niemeyer, D.J., Templin, M., McKillop, I.H., Swan, R.Z., Martinie, J.B., Russo, M.W., Iannitti, D.A.: Survival analysis of patients with stage I and II hepatocellular carcinoma after a liver transplantation or liver resection. HPB (Oxford) 16(12), 1102–1109 (2014). https://doi.org/10.1111/hpb.12300

    Google Scholar 

  17. Harries, L., Gwiasda, J., Qu, Z., Schrem, H., Krauth, C., Amelung, V.E.: Potential savings in the treatment pathway of liver transplantation: an inter-sectorial analysis of cost-rising factors. Eur. J. Heal. Econ. 20, 281–301 (2019). https://doi.org/10.1007/s10198-018-0994-y

    Article  Google Scholar 

  18. Bagaria, S.P., Chang, Y.-H., Gray, R.J., Ashman, J.B., Attia, S., Wasif, N.: Improving long-term outcomes for patients with extra-abdominal soft tissue sarcoma regionalization to high-volume centers, improved compliance with guidelines or both? Sarcoma (2018). https://doi.org/10.1155/2018/8141056

    Article  PubMed  PubMed Central  Google Scholar 

  19. Direção-Geral da Saúde: programas de saúde prioritários—metas de Saúde 2020, Lisbon (2020)

  20. Mestre, A.M., Oliveira, M.D., Barbosa-Póvoa, A.: Organizing hospitals into networks: a hierarchical and multiservice model to define location, supply and referrals in planned hospital systems. OR Spectr. 342(34), 319–348 (2011). https://doi.org/10.1007/S00291-011-0272-1

    Article  Google Scholar 

  21. Martin-Broto, J., Hindi, N., Cruz, J., Martinez-Trufero, J., Valverde, C., De Sande, L.M., Sala, A., Bellido, L., De Juan, A., Rubió-Casadevall, J., Diaz-Beveridge, R., Cubedo, R., Tendero, O., Salinas, D., Gracia, I., Ramos, R., Baguè, S., Gutierrez, A., Duran-Moreno, J., Lopez-Pousa, A.: Relevance of reference centers in sarcoma care and quality item evaluation: results from the prospective registry of the spanish group for research in sarcoma (GEIS). Oncologist. 24, e338–e346 (2019). https://doi.org/10.1634/theoncologist.2018-0121

    Article  PubMed  Google Scholar 

  22. Ray-Coquard, I., Pujade Lauraine, E., Le Cesne, A., Pautier, P., Vacher Lavenue, M.C., Trama, A., Casali, P., Coindre, J.M., Blay, J.Y.: Improving treatment results with reference centres for rare cancers: where do we stand? Eur. J. Cancer. 77, 90–98 (2017). https://doi.org/10.1016/J.EJCA.2017.02.006

    Article  PubMed  Google Scholar 

  23. Leroy, R., Silversmit, G., Stordeur, S., De Gendt, C., Verleye, L., Schillemans, V., Savoye, I., Van Eycken, L., Deron, P., Hamoir, M., Vermorken, J., Grégoire, V., Nuyts, S.: Improved survival in patients with head and neck cancer treated in higher volume centres: a population-based study in Belgium. Eur. J. Cancer. 130, 81–91 (2020). https://doi.org/10.1016/j.ejca.2020.01.024

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank the anonymous referees whose comments helped improve the paper. Margarida Catalão-Lopes gratefully acknowledges financial support from Fundação para Ciência e a Tecnologia (FCT), through UIDB/00097/2020. The authors also thank ACSS (“Administração Central do Sistema de Saúde, I.P.”) for making available the dataset which allowed to conduct this research.

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Authors and Affiliations

  1. Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal

    Manuel Melo Mateus

  2. Centre for Management Studies of Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisbon, Portugal

    Margarida Catalão-Lopes

  3. Faculdade de Medicina da Universidade de Lisboa, Universidade de Lisboa, Lisbon, Portugal

    Rui Portugal

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  1. Manuel Melo Mateus
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  2. Margarida Catalão-Lopes
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  3. Rui Portugal
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Correspondence to Margarida Catalão-Lopes.

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Melo Mateus, M., Catalão-Lopes, M. & Portugal, R. Survival analysis of cancer patients in Portugal following the reference centre model implementation. Eur J Health Econ 24, 157–168 (2023). https://doi.org/10.1007/s10198-022-01461-x

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  • DOI: https://doi.org/10.1007/s10198-022-01461-x

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