Related Experiment Video
Updated: Dec 9, 2025
Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer
Published on: February 12, 2017
Differences in therapy and survival between lung cancer patients treated in hospitals with high and low patient case
Julia Walter1, Amanda Tufman2, Rolf Holle3
1German Research Center for Environmental Health, Institute for Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Ludwig-Maximilians-University Hospital (LMU) Munich, Medical Clinic V - Pneumology, Ziemssenstr. 1, 80336 München, Germany; Ludwig-Maximilians-University Hospital (LMU) Munich, Department of Thoracic Surgery, Marchioninistraße 15, 81377 München, Germany; German Center for Lung Research (DZL), Aulweg 130, 35392 Gießen, Germany.
Background:
In light of political discussions about minimum case volumes and certified lung cancer centers, this observational study investigates differences in therapy and survival between high vs. low patient volume hospitals (HPVH vs. LPVH).
Methods:
We identified 12,374 lung cancer patients treated in HPVH (>67 patients) and LPVH in 2013 from German health insurance claims. Stratified by metastasis status (no metastases, nodal metastases, systemic metastases), we compared HPVHs and LPVHs regarding likelihood of resection and systemic therapy, type of systemic therapy, and surgical outcomes, using multivariate logistic models. Three-year survival was modeled using Cox regression. We adjusted all regression models for age, gender, comorbidity, and residence area, and included a cluster variable for the hospital.
Results:
Around 24 % of patients were treated in HPVHs. Irrespective of stratum and subgroup, three-year survival was significantly better in HPVHs. In patients with systemic metastases (OR = 1.84, CI=[1.22,2.76]) and without metastases (OR = 3.28, CI=[2.13, 5.04]), resection was more likely in HPVHs. Among patients with systemic therapy, the odds of receiving pemetrexed was higher in HPVHs, in patients with nodal metastases (OR = 1.57, CI=[1.01,2.45]). In resected patients without metastases the odds ratio of receiving a thoracoscopic lobectomy was 2.28 (CI=[1.04,4.99]) in HPVHs.
Conclusion:
Our data suggests that case volume is clinically relevant in resected and non-resected lung cancer patients, but optimal minimum case volumes may differ for subgroups.
Related Concept Videos
01:21Cancer Survival Analysis
01:20Comparing the Survival Analysis of Two or More Groups
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:16Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue,...