Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden; Tumorzentrum Regensburg Institut für Qualitätssicherung und Versorgungsforschung, Universität Regensburg; AOK Research Institute, Berlin; Association of German Tumor Centers, Berlin.
Dtsch Arztebl Int. 2023 Sep 29;120(39):647-654. doi: 10.3238/arztebl.m2023.0169.
According to the National Cancer Plan in Germany, all cancer patients should receive high-quality care in accordance with evidence-based treatment guidelines. Certification programs were established for this purpose but have not yet been comprehensively evaluated.
In the WiZen project, which was supported by the Innovation Fund (supported project number 01VSF17020), controlled cohort studies were performed to investigate whether initial treatment in hospitals with or without a certificate from the German Cancer Society was associated with a difference in overall survival (primary endpoint) in patients with cancer of the colon, rectum, lung, pancreas, breast, cervix, prostate, endometrium, and ovary, head and neck cancer, and neuro-oncological tumors. The studies were based on nationwide data from adult insurees of the AOK statutory health insurance carrier for the years 2009-2017.
The majority of patients with all entities except breast cancer received their initial treatment in non-certified hospitals. Initial treatment in a certified hospital was found to be beneficial in terms of overall survival for all cancer entities, even after extensive adjustment for patient- and hospital-related confounders. The hazard ratio (HR) ranged from 0.97 (95% CI: [0.94; 1.00]) for lung cancer to 0.77 [0.74; 0.81] for breast cancer, corresponding to an absolute risk reduction (ARR) for overall survival of 0.62 months for lung cancer to 4.61 months for cervical cancer.
The WiZen study shows for the entities studied that initial cancer treatment in a certified center is associated with lower mortality. Despite the recommendations of the National Cancer Plan, however, more than 40% of all cancer patients still receive their initial treatment in a non-certified hospital. The preferential provision of initial care in certified hospitals would be likely to improve overall survival. Although the study design does not permit any conclusion with regard to causality, the findings seem robust considering that a control group was used, confounders were taken into account, and the study population was of large size.
根据德国国家癌症计划，所有癌症患者都应按照循证治疗指南接受高质量的护理。为此目的建立了认证计划，但尚未进行全面评估。
在由创新基金（受支持项目编号 01VSF17020）支持的 WiZen 项目中，进行了对照队列研究，以调查在具有或不具有德国癌症协会证书的医院中接受初始治疗的癌症患者（结肠癌、直肠癌、肺癌、胰腺癌、乳腺癌、宫颈癌、前列腺癌、子宫内膜癌和卵巢癌、头颈部癌和神经肿瘤学肿瘤）的总体生存率（主要终点）是否存在差异。这些研究基于 2009 年至 2017 年 AOK 法定健康保险公司成年参保人的全国性数据。
除乳腺癌患者外，大多数实体瘤患者都在非认证医院接受初始治疗。在经过广泛调整患者和医院相关混杂因素后，发现认证医院的初始治疗对所有癌症实体的总体生存率有益。总体生存率的危害比（HR）范围从肺癌的 0.97（95%置信区间：[0.94；1.00]）到乳腺癌的 0.77 [0.74；0.81]，对应于肺癌的总体生存率绝对风险降低（ARR）为 0.62 个月，宫颈癌为 4.61 个月。
WiZen 研究表明，在所研究的实体瘤中，在认证中心接受初始癌症治疗与死亡率降低相关。然而，尽管有国家癌症计划的建议，但仍有超过 40%的癌症患者在非认证医院接受初始治疗。在认证医院优先提供初始护理可能会提高总体生存率。尽管研究设计不允许对因果关系得出任何结论，但考虑到使用了对照组、考虑了混杂因素以及研究人群规模较大，这些发现似乎是可靠的。
