Treatment in certified cancer centers is related to better survival in patients with colon and rectal cancer: evidence from a large German cohort study.

BACKGROUND: Certified cancer centers aim to ensure high-quality care by establishing structural and procedural standards according to evidence-based guidelines. Despite the high clinical and health policy relevance, evidence from a nation-wide study for the effectiveness of care for colorectal cancer in certified centers vs. other hospitals in Germany is still missing. METHODS: In a retrospective cohort study covering the years 2009-2017, we analyzed patient data using demographic information, diagnoses, and treatments from a nationwide statutory health insurance enriched with information on certification. We investigated whether patients with incident colon or rectal cancer did benefit from primary therapy in a certified cancer center. We used relative survival analysis taking into account mortality data of the German population and adjustment for patient and hospital characteristics via Cox regression with shared frailty for patients in hospitals with and without certification. RESULTS: The cohorts for colon and rectal cancer consisted of 109,518 and 51,417 patients, respectively, treated in a total of 1052 hospitals. 37.2% of patients with colon and 42.9% of patients with rectal cancer were treated in a certified center. Patient age, sex, comorbidities, secondary malignoma, and distant metastases were similar across groups (certified/non-certified) for both colon and rectal cancer. Relative survival analysis showed significantly better survival of patients treated in a certified center, with 68.3% (non-certified hospitals 65.8%) 5-year survival for treatment of colon cancer in certified (p < 0.001) and 65.0% (58.8%) 5-year survival in case of rectal cancer (p < 0.001), respectively. Cox regression with adjustment for relevant covariates yielded a lower hazard of death for patients treated in certified centers for both colon (HR = 0.92, 95% CI = 0.89-0.95) and rectal cancer (HR = 0.92, 95% CI = 0.88-0.95). The results remained robust in a series of sensitivity analyses. CONCLUSIONS: This large cohort study yields new important evidence that patients with colorectal cancer have a better chance of survival if treated in a certified cancer center. Certification thus provides one powerful means to improve the quality of care for colorectal cancer. To decrease the burden of disease, more patients should thus receive cancer care in a certified center.

[Methodology and Attribution Success of a Data Linkage of Clinical Registry Data with Health Insurance Data]. / Methodik und Zuordnungserfolg eines Linkage von Daten klinischer Krebsregister mit Abrechnungsdaten gesetzlicher Krankenkassen.

BACKGROUND: The aim of the project "Effectiveness of care in oncological centres" (WiZen), funded by the innovation fund of the federal joint committee, is to investigate the effectiveness of certification in oncology. The project uses nationwide data from the statuory health insurance AOK and data from clinical cancer registries from three different federal states from 2006-2017. To combine the strengths of both data sources, these will be linked for eight different cancer entities in compliance with data protection regulations. METHODS: Data linkage was performed using indirect identifiers and validated using the health insurance's patient ID ("Krankenversichertennummer") as a direct identifier and gold standard. This enables quantification of the quality of different linkage variants. Sensitivity and specificity as well as hit accuracy and a score addressing the quality of the linkage were used as evaluation criteria. The distributions of relevant variables resulting from the linkage were validated against the original distributions in the individual datasets. RESULTS: Depending on the combination of indirect identifiers, we found a range of 22,125 to 3,092,401 linkage hits. An almost perfect linkage could be achieved by combining information on cancer type, date of birth, gender and postal code. A total of 74,586 one-to-one linkages were achieved with these characteristics. The median hit quality for the different entities was more than 98%. In addition, both the age and sex distributions and the dates of death, if any, showed a high degree of agreement. DISCUSSION AND CONCLUSION: SHI and cancer registry data can be linked with high internal and external validity at the individual level. This robust linkage enables completely new possibilities for analysis through simultaneous access to variables from both data sets ("the best of both worlds"): Information on the UICC stage that stems from the registries can now be combined, for instance, with comorbidities from the SHI data at the individual level. Due to the use of readily available variables and the high success of the linkage, our procedure constitutes a promising method for future linkage processes in health care research.

Is treatment in certified cancer centers related to better survival in patients with pancreatic cancer? Evidence from a large German cohort study.

BACKGROUND: Treatment of cancer patients in certified cancer centers, that meet specific quality standards in term of structures and procedures of medical care, is a national treatment goal in Germany. However, convincing evidence that treatment in certified cancer centers is associated with better outcomes in patients with pancreatic cancer is still missing. METHODS: We used patient-specific information (demographic characteristics, diagnoses, treatments) from German statutory health insurance data covering the period 2009-2017 and hospital characteristics from the German Standardized Quality Reports. We investigated differences in survival between patients treated in hospitals with and without pancreatic cancer center certification by the German Cancer Society (GCS) using the Kaplan-Meier estimator and Cox regression with shared frailty. RESULTS: The final sample included 45,318 patients with pancreatic cancer treated in 1,051 hospitals (96 GCS-certified, 955 not GCS-certified). 5,426 (12.0%) of the patients were treated in GCS-certified pancreatic cancer centers. Patients treated in certified and non-certified hospitals had similar distributions of age, sex, and comorbidities. Median survival was 8.0 months in GCS-certified pancreatic cancer centers and 4.4 months in non-certified hospitals. Cox regression adjusting for multiple patient and hospital characteristics yielded a significantly lower hazard of long-term, all-cause mortality in patients treated in GCS-certified pancreatic centers (Hazard ratio = 0.89; 95%-CI = 0.85-0.93). This result remained robust in multiple sensitivity analyses, including stratified estimations for subgroups of patients and hospitals. CONCLUSION: This robust observational evidence suggests that patients with pancreatic cancer benefit from treatment in a certified cancer center in terms of survival. Therefore, the certification of hospitals appears to be a powerful strategy to improve patient outcomes in pancreatic cancer care. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT04334239 ).

Enhanced Electromagnetic Corrections to the Rare Decay B_{s,d}→µ

We investigate electromagnetic corrections to the rare B-meson leptonic decay B_{s,d}→µ^{+}µ^{-} from scales below the bottom-quark mass m_{b}. Contrary to QCD effects, which are entirely contained in the B-meson decay constant, we find that virtual photon exchange can probe the B-meson structure, resulting in a "nonlocal annihilation" effect. We find that this effect gives rise to a dynamical enhancement by a power of m_{b}/Λ_{QCD} and by large logarithms. The impact of this novel effect on the branching ratio of B_{s,d}→µ^{+}µ^{-} is about 1%, of the order of the previously estimated nonparametric theoretical uncertainty, and four times the size of previous estimates of next-to-leading order QED effects due to residual scale dependence. We update the standard model (SM) prediction to B[over ¯](B_{s}→µ^{+}µ^{-})_{SM}=(3.57±0.17)×10^{-9}.

B(s,d)→ℓ(+)ℓ(-) in the standard model with reduced theoretical uncertainty.

We combine our new results for the O(αem) and O(αs2) corrections to Bs,d→ℓ+ℓ-, and present updated branching ratio predictions for these decays in the standard model. Inclusion of the new corrections removes major theoretical uncertainties of perturbative origin that have just begun to dominate over the parametric ones. For the recently observed muonic decay of the Bs meson, our calculation gives B¯(Bs→µ+µ-)=(3.65±0.23)×10-9.

Hospital admissions following emergency medical services in Germany: analysis of 2 million hospital cases in 2022.

BACKGROUND: The use of emergency medical services (EMS) in Germany has increased substantially over the last few decades. While current reform efforts aim to increase effectiveness and efficiency of the German hospital and EMS systems, there is lack of data on characteristics of hospital cases using EMS. OBJECTIVES: To analyze and compare the characteristics of cases hospitalized with and without the use of EMS. MATERIALS AND METHODS: The BARMER health insurance data on more than 2 million hospital cases admitted in 2022 were analyzed. The distributions of age, clinical complexity (measured by patient clinical complexity levels, PCCL), main diagnoses, costs for EMS and hospital treatment, and multiple severity indicators were described. The overall severity of hospital cases was classified as "low or moderate" or "high" based on a combined severity indicator. All analyses were stratified by use of EMS and EMS type. RESULTS: A total of 28% of all included hospital cases used EMS. Relative to hospital cases without use of EMS, hospital cases with use of EMS were older (physician-staffed ambulance: 75 years, interquartile range [IQR] 59-84, double-crewed ambulance: 78 years, IQR 64-85) and had a higher clinical complexity. The severity of more than 30% of the cases using EMS (except for patient transport service ambulance) was classified as "low or moderate". The distributions of main diagnoses differed by severity and use of EMS. CONCLUSIONS: The high proportion of cases with low or moderate severity using EMS may indicate a substantial potential to avoid the use of EMS in the context of hospital admissions in Germany. Further investigation is required to explore whether the proportion of cases using EMS could be reduced by optimizing preclinical service.

Treatment in Certified Breast Cancer Centers Improves Chances of Survival of Patients with Breast Cancer: Evidence Based on Health Care Data from the WiZen Study.

Introduction: Certified breast cancer centers offer specific quality standards in terms of their structure, diagnostic and treatment approaches with regards to breast surgery, drug-based cancer therapy, radiotherapy, and psychosocial support. Such centers aim to improve treatment outcomes of breast cancer patients. The question investigated here was whether patients with primary breast cancer have a longer overall survival if they are treated in a certified breast cancer center compared to treatment outside these centers. Methods: We used patient-specific data (demographics, diagnoses, treatments) obtained from data held by mandatory health insurance companies ( gesetzliche Krankenversicherung , GKV) and clinical cancer registries (KKR) for the period 2009-2017 as well as hospital characteristics recorded in standardized quality reports. Using multivariable Cox regression analysis, we investigated differences in survival between patients treated in hospitals certified as breast cancers centers by the German Cancer Society (DKG) and patients treated in hospitals which had not been certified by the DKG. Results: The sample population consisted of 143720 (GKV data) and 59780 (KKR data) patients with breast cancer, who were treated in 1010 hospitals across Germany (280 DKG-certified, 730 not DKG-certified). 63.5% (GKV data) and 66.7% (KKR data) of patients, respectively, were treated in DKG-certified breast cancer centers. Cox regression analysis for overall survival which included patient and hospital characteristics found a significantly lower mortality risk for patients treated in DKG-certified breast cancer centers (GKV data: HR = 0.77, 95% CI = 0.74-0.81; KKR data: HR = 0.88, 95% CI = 0.85-0.92). This result remained stable even after several sensitivity analyses including stratified estimates for subgroups of patients and hospitals. The effect was even more pronounced for recurrence-free survival (KKR data: HR = 0.78, 95% CI = 0.74-0.82). Conclusions: Patients who are treated by an interdisciplinary team in a DKG-certified breast cancer had clear and statistically significantly better survival rates. Certification is therefore an effective means of improving the quality of care, and more patients should be treated in certified breast cancer centers.

Initial Cancer Treatment in Certified Versus Non-Certified Hospitals.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Treatment of Colorectal Cancer in Certified Centers: Results of a Large German Registry Study Focusing on Long-Term Survival.

(1) Background: The WiZen study is the largest study so far to analyze the effect of the certification of designated cancer centers on survival in Germany. This certification program is provided by the German Cancer Society (GCS) and represents one of the largest oncologic certification programs worldwide. Currently, about 50% of colorectal cancer patients in Germany are treated in certified centers. (2) Methods: All analyses are based on population-based clinical cancer registry data of 47.440 colorectal cancer (ICD-10-GM C18/C20) patients treated between 2009 and 2017. The primary outcome was 5-year overall survival (OAS) after treatment at certified cancer centers compared to treatment at other hospitals; the secondary endpoint was recurrence-free survival. Statistical methods included Kaplan-Meier analysis and multivariable Cox regression. (3) Results: Treatment at certified hospitals was associated with significant advantages concerning 5-year overall survival (HR 0.92, 95% CI 0.89, 0.96, adjusted for a broad range of confounders) for colon cancer patients. Concentrating on UICC stage I-III patients, for whom curative treatment is possible, the survival benefit was even larger (colon cancer: HR 0.89, 95% CI 0.84, 0.94; rectum cancer: HR 0.91, 95% CI 0.84, 0.97). (4) Conclusions: These results encourage future efforts for further implementation of the certification program. Patients with colorectal cancer should preferably be directed to certified centers.

ε ' / ε in the Standard Model at the Dawn of the 2020s.

We reanalyse the ratio ε ' / ε in the Standard Model (SM) using most recent hadronic matrix elements from the RBC-UKQCD collaboration in combination with most important NNLO QCD corrections to electroweak penguin contributions and the isospin-breaking corrections. We illustrate the importance of the latter by using their latest estimate from chiral perturbation theory (ChPT) based on the octet approximation for lowest-lying mesons and a very recent estimate in the nonet scheme that takes into account the contribution of η 0 . We find ( ε ' / ε ) SM ( 8 ) = ( 17.4 ± 6.1 ) × 10 - 4 and ( ε ' / ε ) SM ( 9 ) = ( 13.9 ± 5.2 ) × 10 - 4 , respectively. Despite a very good agreement with the measured value ( ε ' / ε ) exp = ( 16.6 ± 2.3 ) × 10 - 4 , the large error in ( ε ' / ε ) SM still leaves room for significant new physics (BSM) contributions to this ratio. We update the 2018 master formula for ( ε ' / ε ) BSM valid in any extension beyond the SM without additional light degrees of freedom. We provide new values of the penguin parameters B 6 ( 1 / 2 ) ( µ ) and B 8 ( 3 / 2 ) ( µ ) at the µ -scales used by the RBC-UKQCD collaboration and at lower scales O ( 1 GeV ) used by ChPT and Dual QCD (DQCD). We present semi-analytic formulae for ( ε ' / ε ) SM in terms of these parameters and Ω ^ eff that summarizes isospin-breaking corrections to this ratio. We stress the importance of lattice calculations of the O ( α em ) contributions to the hadronic matrix elements necessary for the removal of renormalization scheme dependence at O ( α em ) in the present analyses of ε ' / ε .

Constraints on tensor and scalar couplings from [Formula: see text] and [Formula: see text].

The angular distribution of [Formula: see text] ([Formula: see text]) depends on two parameters, the lepton forward-backward asymmetry, [Formula: see text], and the flat term, [Formula: see text]. Both are strongly suppressed in the standard model and constitute sensitive probes of tensor and scalar contributions. We use the latest experimental results for [Formula: see text] in combination with the branching ratio of [Formula: see text] to derive the strongest model-independent bounds on tensor and scalar effective couplings to date. The measurement of [Formula: see text] provides a complementary constraint to that of the branching ratio of [Formula: see text] and allows us - for the first time - to constrain all complex-valued (pseudo-)scalar couplings and their chirality-flipped counterparts in one fit. Based on Bayesian fits of various scenarios, we find that our bounds even become tighter when vector couplings are allowed to deviate from the standard model and that specific combinations of angular observables in [Formula: see text] are still allowed to be up to two orders of magnitude larger than in the standard model, which would place them in the region of LHCb's sensitivity.

Weak annihilation and new physics in charmless [Formula: see text] decays.

We use currently available data of nonleptonic charmless 2-body [Formula: see text] decays ([Formula: see text]) that are mediated by [Formula: see text] QCD- and QED-penguin operators to study weak annihilation and new-physics effects in the framework of QCD factorization. In particular we introduce one weak-annihilation parameter for decays related by [Formula: see text] quark interchange and test this universality assumption. Within the standard model, the data supports this assumption with the only exceptions in the [Formula: see text] system, which exhibits the well-known "[Formula: see text] puzzle", and some tensions in [Formula: see text]. Beyond the standard model, we simultaneously determine weak-annihilation and new-physics parameters from data, employing model-independent scenarios that address the "[Formula: see text] puzzle", such as QED-penguins and [Formula: see text] current-current operators. We discuss also possibilities that allow further tests of our assumption once improved measurements from LHCb and Belle II become available.

Comprehensive Bayesian analysis of rare (semi)leptonic and radiative [Formula: see text] decays.

The available data on [Formula: see text] decays are in good agreement with the Standard Model when permitting subleading power corrections of about [Formula: see text] at large hadronic recoil. Constraining new-physics effects in [Formula: see text], [Formula: see text], [Formula: see text], the data still demand the same size of power corrections as in the Standard Model. In the presence of chirality-flipped operators, all but one of the power corrections reduce substantially. The Bayes factors are in favor of the Standard Model. Using new lattice inputs for [Formula: see text] form factors and under our minimal prior assumption for the power corrections, the favor shifts toward models with chirality-flipped operators. We use the data to further constrain the hadronic form factors in [Formula: see text] and [Formula: see text] transitions.