Evaluating the German oncology certification system and its implications
for colorectal carcinoma - a national and international comparison of
relative survival rates.
Abstract
Rationale, aims and objectives In order to evaluate how the
certification of specialised Oncology Centres in Germany affects the
relative survival of patients with colorectal cancer (CRC), a national
and international comparison was performed. Method Between 2007 and
2013, 675 patients with colorectal cancer treated at the Hildesheim
Hospital, an academic teaching hospital of the Hanover Medical School
(MHH), were included. A follow up of the entire patient group was
performed until 2014. To obtain international data, a SEER-database
search was done. The relative survival of 148,957 patients was compared
to our data after 12, 36 and 60 months. For national survival data, we
compared our rates with 36,048 patients of the Munich Cancer Registry
(MCR) Results Relative survival at Certified Oncology Centres was
significantly higher in advanced tumour stages compared with national
and international cancer registry data. Nationally, we found only little
variation in survival rates for low stage (UICC I, II) CRC, colon, and
rectal carcinoma. Both colon and rectal carcinoma showed notable
variations in their relative survival rates for advanced tumour stages.
These variations were even more distinct for rectal carcinoma
(Hildesheim Hospital: 89.9%, 40.3%, 30.1%; Munich Cancer Registry
(MCR): 63.6%, 26.2%, 15.2%). The international comparison for
colorectal cancer, colon cancer and rectal cancer showed significantly
higher survival rates for patients with advanced tumour stages at the
Certified Cancer Centre. CRC (UICC IV) at month 12 had a relative
survival of 77% whereas the international survival was only 54,9% (raw
p<0.001). Conclusion Our findings suggest that patients with
advanced tumour stages of CRC and rectal cancer, benefit most from
multidisciplinary treatment at Certified Oncology Centres as compared to
low stage CRC and rectal carcinoma. However, the creation of unified
national registry data bases is necessary for future evaluation of
cancer treatment and improved international comparison.