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Background: The EUROCARE-5 study revealed disparities in childhood cancer survival among European countries, giving rise to important initiatives across Europe to reduce the gap. Extending its representativeness through increased coverage of eastern European countries, the EUROCARE-6 study aimed to update survival progress across countries and years of diagnosis and provide new analytical perspectives on estimates of long-term survival and the cured fraction of patients with childhood cancer. Methods: In this population-based study, we analysed 135 847 children (aged 0–14 years) diagnosed during 2000–13 and followed up to the end of 2014, recruited from 80 population-based cancer registries in 31 European countries. We calculated age-adjusted 5-year survival differences by country and over time using period analysis, for all cancers combined and for major cancer types. We applied a variant of standard mixture cure models for survival data to estimate the cure fraction of patients by childhood cancer and to estimate projected 15-year survival. Findings: 5-year survival for all childhood cancer combined in Europe in 2010–14 was 81% (95% CI 81–82), showing an increase of three percentage points compared with 2004–06. Significant progress over time was observed for almost all cancers. Survival remained stable for osteosarcomas, Ewing sarcoma, Burkitt lymphoma, non-Hodgkin lymphomas, and rhabdomyoscarcomas. For all cancers combined, inequalities still persisted among European countries (with age-adjusted 5-year survival ranging from 71% [95% CI 60–79] to 87% [77–93]). The 15-year survival projection for all patients with childhood cancer diagnosed in 2010–13 was 78%. We estimated the yearly long-term mortality rate due to causes other than the diagnosed cancer to be around 2 per 1000 patients for all childhood cancer combined, but to approach zero for retinoblastoma. The cure fraction for patients with childhood cancer increased over time from 74% (95% CI 73–75) in 1998–

Quality indicators (QIs) for the management of breast cancer (BC) have been published in Europe and internationally. In Belgium, a task force was established to select measurable process indicators of systemic treatment for BC, focusing on appropriateness of delivered care. The objective of this study was to evaluate the results of the selected QIs, both nationally and among individual centres. Female Belgian residents with unilateral primary invasive BC diagnosed between 2010 and 2014 were selected from the Belgian Cancer Registry database. The national number enabled linkage with the national reimbursement database, which contains information on all reimbursed medical procedures. A total of 12 process indicators were measured on the population and hospital level. Intercentre variability was assessed by median results and interquartile ranges. A total of 48 872 patients were included in the study. QIs concerning specific BC subtypes only applied to patients diagnosed in 2014 (n = 9855). Clinical stage (cStage) I patients (n = 17 116) were staged with positron emission tomography/computed tomography. Among patients who were pT1aN0 human epidermal growth factor receptor 2 (HER2) positive (n = 47), 25.5% (n = 12) received adjuvant trastuzumab. Among patients with de novo metastatic luminal A/B-like HER2-negative BC (n = 295), 17.3% (n = 51) received upfront chemotherapy. (Neo)adjuvant chemotherapy was administered in 52.4% (n = 12 592) of operated women with cStage I-III, in 37.0% (n = 1270) of operated women with cStage I-III luminal A/B-like HER2-negative BC, and in 19.1% of operated women with cStage I luminal A/B-like HER2-negative BC. In the population of operated patients with cStage I-III, of those younger than 70 years that started adjuvant endocrine therapy (n = 3591), 81.7% (n = 2932) continued treatment for ≥4.5 years. Among patients in cStage I-III older than 70 years (n = 8544), 19.0% (n = 1622) received (neo)adjuvant chemotherapy, whereas among patients

Background: Elderly patients with pancreatic cancer are underrepresented in clinical trials, resulting in a lack of evidence. Objective: The aim of this study was to compare treatment and overall survival (OS) of patients aged ≥ 70 years with stage I–II pancreatic cancer in the EURECCA Pancreas Consortium. Methods: This was an observational cohort study of the Belgian (BE), Dutch (NL), and Norwegian (NOR) cancer registries. The primary outcome was OS, while secondary outcomes were resection, 90-day mortality after resection, and (neo)adjuvant and palliative chemotherapy. Results: In total, 3624 patients were included. Resection (BE: 50.2%; NL: 36.2%; NOR: 41.3%; p < 0.001), use of (neo)adjuvant chemotherapy (BE: 55.9%; NL: 41.9%; NOR: 13.8%; p < 0.001), palliative chemotherapy (BE: 39.5%; NL: 6.0%; NOR: 15.7%; p < 0.001), and 90-day mortality differed (BE: 11.7%; NL: 8.0%; NOR: 5.2%; p < 0.001). Furthermore, median OS in patients with (BE: 17.4; NL: 15.9; NOR: 25.4 months; p < 0.001) and without resection (BE: 7.0; NL: 3.9; NOR: 6.5 months; p < 0.001) also differed. Conclusions: Differences were observed in treatment and OS in patients aged ≥ 70 years with stage I–II pancreatic cancer, between the population-based cancer registries. Future studies should focus on selection criteria for (non)surgical treatment in older patients so that clinicians can tailor treatment.

BackgroundIn the randomized Asian REGATTA trial, no survival benefit was shown for additional gastrectomy over chemotherapy alone in patients with advanced gastric cancer with a single incurable factor, thereby discouraging surgery for these patients. The purpose of this study was to evaluate treatment strategies for patients with metastatic gastric cancer in daily practice in five European countries, along with relative survival in each country. MethodsNationwide population-based data from Belgium, Denmark, the Netherlands, Norway and Sweden were combined. Patients with primary metastatic gastric cancer diagnosed between 2006 and 2014 were included. The proportion of gastric resections performed and the administration of chemotherapy (irrespective of surgery) within each country were determined. Relative survival according to country was calculated. ResultsOverall, 15 057 patients with gastric cancer were included. The proportion of gastric resections varied from 81 per cent in the Netherlands and Denmark to 183 per cent in Belgium. Administration of chemotherapy was 392 per cent in the Netherlands, compared with 632 per cent in Belgium. The 6-month relative survival rate was between 390 (95 per cent c.i. 378 to 402) per cent in the Netherlands and 541 (521 to 569) per cent in Belgium. ConclusionThere is variation in the use of gastrectomy and chemotherapy in patients with metastatic gastric cancer, and subsequent differences in survival.

Background: Decreased cancer specific survival in older colorectal patients is mainly due to mortality in the first year, emphasizing the importance of the first postoperative year. This study aims to gain an overview and time trends of short-term mortality in octogenarians (>= 80 years) with colorectal cancer across four North European countries.Methods: Patients of 80 years or older, operated for colorectal cancer (stage I-Ill) between 2005 and 2014, were included. Population-based cohorts from Belgium, Denmark, the Netherlands, and Sweden were collected. Separately for colon- and rectal cancer, 30-day, 90-day, one-year, and excess one-year mortality were calculated. Also, short-term mortality over three time periods (2005-2008, 2009-2011, 2012-2014) was analyzed.Results: In total, 35,158 colon cancer patients and 10,144 rectal cancer patients were included. For colon cancer, 90-day mortality rate was highest in Denmark (15%) and lowest in Sweden (8%). For rectal cancer, 90-day mortality rate was highest in Belgium (11%) and lowest in Sweden (7%). One-year excess mortality rate of colon cancer patients decreased from 2005 to 2008 to 2012-2014 for all countries (Belgium: 17%-11%, Denmark: 21%-15%, the Netherlands: 18%-10%, and Sweden: 10%-8%). For rectal cancer, from 2005 to 2008 to 2012-2014 one-year excess mortality rate decreased in the Netherlands from 16% to 7% and Sweden: 8%-2%).Conclusions: Short-term mortality rates were high in octogenarians operated for colorectal cancer. Short-term mortality rates differ across four North European countries, but decreased over time for both colon and rectal cancer patients in all countries. (C) 2019 Published by Elsevier Ltd.

11 pp., Aims: The study assessed the quality of diagnosis and staging offered to patients with a head and neck squamous cell carcinoma (HNSCC) and the variability across Belgian hospitals. Methods: In total, 9,245 patients diagnosed with HNSCC between 2009 and 2014, were identified in the population-based Belgian Cancer Registry (BCR). The BCR data were coupled with other databases providing information on diagnostic and therapeutic procedures reimbursed by the compulsory health insurance, vital status data, and comorbidities. The use of diagnosis and staging procedures was assessed by four quality indicators (QI) (i.e., use of dedicated head and neck imaging studies, use of PET-CT, TNM reporting and interval between diagnosis and start of treatment), for which a target was defined before the analysis. The association between the binary QIs and observed survival was assessed using Cox proportional hazard models adjusted for potential confounders. Results: Overall, 82.5% of patients received staging by MRI and/or CT of the head and neck region before the start of treatment. In 47.6% of stage III-IV patients eligible for treatment with curative intent, a whole-body FDG-PET(/CT) was performed. The proportion of patients whose cTNM and pTNM stage was reported to the BCR was 80.5 and 78.4%, respectively. The median interval from diagnosis to first treatment with curative intent was 32 days (IQR: 19-46). For none of these QIs the pre-set targets were reached and a substantial variability between centers was observed for all quality indicators. No binary QI was significantly associated with observed survival. Conclusions: The four quality indicators related to diagnosis and staging in HNSCC all showed substantial room for improvement. For none of them the pre-set targets were met at the national level and the variability between centers was substantial. Each Belgian hospital received an individual feedback report in order to stimulate reflection and quality improvement processes.

Introduction: The aim of this EURECCA international comparison is to compare oncologic treatment strategies and relative survival of patients with stage I-III rectal cancer between European countries. Material and methods: Population-based national cohort data from the Netherlands (NL), Belgium (BE), Denmark (DK), Sweden (SE), England (ENG), Ireland (IE), Spain (ES), and single-centre data from Lithuania (LT) were obtained. All operated patients with (y)pTNM stage I-III rectal cancer diagnosed between 2004 and 2009 were included. Oncologic treatment strategies and relative survival were calculated and compared between neighbouring countries. Results: We included 57,120 patients. Treatment strategies differed between NL and BE (p < 0.001), DK and SE (p < 0.001), and ENG and IE (p < 0.001). More preoperative radiotherapy as single treatment before surgery was administered in NL compared with BE (59.7% vs. 13.1%), in SE compared with DK (55.1% vs. 10.4%), and in ENG compared with IE (15.2% vs. 9.6%). Less postoperative chemotherapy was given in NL (9.6% vs. 39.1%), in SE (7.9% vs. 14.1%), and in IE (12.6% vs. 18.5%) compared with their neighbouring country. In ES, 55.1% of patients received preoperative chemoradiation and 62.3% post-operative chemotherapy. There were no significant differences in relative survival between neighbouring countries. Conclusion: Large differences in oncologic treatment strategies for patients with (y)pTNM I-III rectal cancer were observed across European countries. No clear relation between oncologic treatment strategies and relative survival was observed. Further research into selection criteria for specific treatments could eventually lead to individualised and optimal treatment for patients with non-metastasised rectal cancer.

74 p., ill., In het kader van haar plannen voor de hervorming van het ziekenhuislandschap vroeg minister De Block aan het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) om na te gaan hoeveel bedden de Belgische algemene ziekenhuizen in 2025 nodig zullen hebben. Het blijkt dat er vandaag in het algemeen al teveel capaciteit is, en dat deze trend zich zal voortzetten. De grote uitzondering hierop zijn de bedden voor geriatrie en revalidatie, waaraan er nu reeds een tekort is, dat alleen maar zal toenemen. We moeten ook nog veel meer in het dagziekenhuis behandelen dan nu het geval is. Het KCE onderzocht ook de huidige en toekomstige behoeften voor een aantal specifieke types van zorg: de materniteiten, complexe kankerchirurgie en radiotherapie. Operaties bij complexe kankers en radiotherapie zouden enkel nog mogen worden uitgevoerd in een klein aantal ziekenhuizen, met gespecialiseerde expertise, die zo voldoende ervaring kunnen opbouwen en behouden. Hierdoor verhoogt de kans op overleving van de patiënt. Er zijn daarnaast teveel kleine materniteiten die maar 1 of twee bevallingen per dag hebben. Het KCE berekende dat we tegen 2025 een derde van de huidige bedden in de materniteiten kunnen sluiten., VOORWOORD.1 -- SYNTHESE2 -- 1. ACHTERGROND 7 -- 1.1. HUIDIGE SAMENWERKING TUSSEN DE BELGISCHE ZIEKENHUIZEN LEIDT NIET TOT BETERE TAAKVERDELING 7 -- 1.2. NAAR EEN HERVORMING VAN HET ZIEKENHUISLANDSCHAP.8 -- 1.2.1. KCE rapport van 2014: een kader voor een hervormd ziekenhuislandschap 8 -- 1.2.2. Hervormingsplannen van de huidige minister: van ‘Plan van Aanpak’ naar een concrete Conceptnota.8 -- 1.2.3. De rol van programmatie in de huidige ziekenhuishervorming 9 -- 1.2.4. Opdracht van deze studie: berekening benodigde ziekenhuiscapaciteit en bepalen van programmatiecriteria voor een selectie van zorgopdrachten 10 -- 2. CAPACITEITSPLANNING AAN DE HAND VAN EEN TRENDANALYSE.10 -- 2.1. CAPACITEITSPLANNING: AFSTEMMING OP DE BEHOEFTEN VAN DE BEVOLKING IS NODIG10 2.2. CAPACITEITSPLANNING MET BEHULP VAN EEN TRENDANALYSE .11 -- 2.2.1. Trends leren ons wat in het verleden gebeurde en wat we in de toekomst kunnen verwachten 11 -- 2.2.2. ‘Wat als’ scenario’s zijn nodig om opkomende trends en eenmalige veranderingen te vatten 11 -- 3. HUIDIGE TRENDS EN VOORSPELLINGEN VOOR 2025 12 -- 3.1. TRENDANALYSE: DEMOGRAFISCHE EN ANDERE ONTWIKKELINGEN 12 -- 3.2. DE BEVOLKINGSGROEI EN DE VERGRIJZING ZULLEN HET AANTAL KLASSIEKE ZIEKENHUISVERBLIJVEN MET BIJNA 12% DOEN TOENEMEN 13 -- 3.3. GEMIDDELDE VERBLIJFSDUUR BLIJFT VERDER INKRIMPEN 13 -- 3.3.1. Jaarlijkse vermindering met 1,5% of met 1 dag op 10 jaar tijd…13 -- 3.3.2. …voor bijna alle aandoeningen . 13 -- 3.3.3. Een snellere inkorting van de verblijfsduur bij de minder ernstige gevallen 14 -- 3.4. EEN AFNAME VAN HET AANTAL VERPLEEGDAGEN MET 5%, MET EEN VERSCHUIVING VAN ACUTE NAAR CHRONISCHE ZORG 15 -- 3.4.1. Door verblijven in te korten, kan men capaciteit voor een groter aantal verblijven creëren .15 -- 3.4.2. Minder verpleegdagen voor 2 op de 3 pathologiegroepen, met een verschuiving van acute -- naar chronische zorg . 17 -- 3.5. GROTE TOENAME VAN DAGOPNAMES 17 -- 3.6. DEMOGRAFISCHE VERSCHILLEN TUSSEN DE REGIO’S VRAGEN EEN AANGEPASTE BENADE

328 p., ill., Accompanying explanation 1 -- MDC PP pre-MDC 2 -- APR-DRG 001 Liver Transplant And/Or Intestinal Transplant 2 -- APR-DRG 002 Heart &/Or Lung Transplant 3 -- APR-DRG 003 Bone Marrow Transplant 4 -- APR-DRG 004 Ecmo Or Tracheostomy With Long Term Mechanical Ventilation With Extensive Procedure or ECMO 5 -- APR-DRG 005 Tracheostomy W Long Term Mechanical Ventilation W/O Extensive Proc 6 -- APR-DRG 006 Pancreas Transplant 7 -- MDC 01 Diseases & disorders of the nervous system 8 -- APR-DRG 020 Craniotomy For Trauma 8 -- APR-DRG 021 Craniotomy Except For Trauma 9 -- APR-DRG 022 Ventricular Shunt Procedures 10 -- APR-DRG 023 Spinal Procedures 11 -- APR-DRG 024 Extracranial Vascular Procedures 12 -- APR-DRG 026 Other Nervous System & Related Procedures 13 -- APR-DRG 040 Spinal Disorders & Injuries 14 -- APR-DRG 041 Nervous System Malignancy 15 -- APR-DRG 042 Degenerative Nervous System Disorders Exc Multiple Sclerosis 16 -- APR-DRG 043 Multiple Sclerosis & Other Demyelinating Diseases 17 -- APR-DRG 044 Intracranial Hemorrhage 18 -- APR-DRG 045 Cerebral Vascular Accident and Precerebral Occlusion with infarct 19 -- APR-DRG 046 Nonspecific Cva & Precerebral Occlusion W/O Infarct 20 -- APR-DRG 047 Transient Ischemia 21 -- APR-DRG 048 Peripheral,Cranial & Autonomic Nerve Disorders 22 -- APR-DRG 049 Bacterial & Tuberculous Infections Of Nervous System 23 -- APR-DRG 050 Non-Bacterial Infections Of Nervous System Exc Viral Meningitis 24 -- APR-DRG 051 Viral Meningitis 25 -- APR-DRG 052 Nontraumatic Stupor & Coma 26 -- APR-DRG 053 Seizure 27 -- APR-DRG 054 Migraine & Other Headaches 28 -- APR-DRG 055 Head Trauma W Coma > 1 Hr Or Hemorrhage 29 -- APR-DRG 056 Brain Contusion/.Laceration & Complicated Skull Fx, Coma < 1Hr Or 30 -- APR-DRG 057 Concussion, Closed Skull Fx Nos, Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma 31 -- APR-DRG 058 Other Disorders Of Nervous System 32 -- MDC 02 Diseases & disorders of the eye 33 -- APR-DRG 070 Orbital Procedures 33 -- APR-DRG 073 Eye

74 p., ill., Dans le cadre de ses plans de réforme du paysage hospitalier, la ministre De Block a demandé au Centre fédéral d’Expertise des Soins de Santé (KCE) de calculer le nombre de lits dont nous aurons besoin dans les hôpitaux généraux en 2025. Il semble que nous ayons déjà une capacité trop élevée à l’heure actuelle et que cette situation va encore se marquer davantage dans les années à venir. Quelques exceptions importantes à ce constat : il manque de lits pour les patients gériatriques et la revalidation, et ces déficits vont encore se creuser. Il faut également traiter beaucoup plus de patients en hôpital de jour. Le KCE a également analysé les besoins actuels et à venir pour quelques types de soins spécifiques : les maternités, la chirurgie des cancers complexes et la radiothérapie. Conclusion : les interventions pour cancers complexes et la radiothérapie ne devraient être pratiquées que dans quelques hôpitaux détenant une expertise spécialisée, qui développent et maintiennent une expérience suffisante, car cela augmente les chances de survie pour le patient. Il y a par ailleurs trop de petites maternités où l’on ne pratique que un ou deux accouchements par jour ; le KCE a calculé que l’on devra fermer un tiers des lits actuels de maternité d’ici 2025.,  PRÉFACE. 1 --  SYNTHÈSE . 2 -- 1. CONTEXTE. 8 -- 1.1. DANS SA FORME ACTUELLE, LA COLLABORATION ENTRE LES HÔPITAUX BELGES N’AMÉLIORE PAS LA RÉPARTITION DES TÂCHES . 8 -- 1.2. VERS UNE RÉFORME DU PAYSAGE HOSPITALIER 9 -- 1.2.1. Rapport 2014 du KCE : un cadre pour une réforme du paysage hospitalier 9 -- 1.2.2. Les projets de réforme de la ministre actuelle : d’un « Plan d’Approche » à une note conceptuelle concrète . 9 -- 1.2.3. Le rôle de la programmation dans la réforme hospitalière actuelle 10 -- 1.2.4. Objectif de la présente étude : évaluer la capacité hospitalière requise et définir les critères de programmation pour un certain nombre de missions de soins 11 -- 2. PLANIFICATION DE LA CAPACITÉ À L’AIDE D’UNE ANALYSE DES TENDANCES 12 -- 2.1. PLANIFICATION DE LA CAPACITÉ EN FONCTION DES BESOINS DE LA POPULATION 12 -- 2.2. PLANIFICATION DE LA CAPACITÉ À L’AIDE D’UNE ANALYSE DES TENDANCES.12 -- 2.2.1. Les tendances nous renseignent sur le passé et nous prédisent ce que l’avenir pourrait nous réserver 12 -- 2.2.2. Des scénarios de type « et si… » sont nécessaires pour cerner les tendances émergentes et les changements ponctuels 13 -- 3. TENDANCES ACTUELLES ET PRÉVISIONS À L’HORIZON 2025 .13 -- 3.1. ANALYSE DES TENDANCES : DÉVELOPPEMENTS DÉMOGRAPHIQUES ET AUTRES .13 -- 3.2. LES HOSPITALISATIONS CLASSIQUES EN HAUSSE DE PRÈS DE 12 % SOUS L’EFFET DE LA CROISSANCE DE LA POPULATION ET DU VIEILLISSEMENT .14 -- 3.3. LA DURÉE DE SÉJOUR CONTINUE À SE RACCOURCIR 15 -- 3.3.1. Une baisse annuelle de 1,5 %, soit 1 jour sur une période de 10 ans…15 -- 3.3.2. … pour presque toutes les pathologies 15 -- 3.3.3. Une baisse plus rapide pour les cas les moins sévères .15 -- 3.4. UNE BAISSE DE 5 % DU NOMBRE DE JOURNÉES D’HOSPITALISATION, AVEC UN GLISSEMENT DES SOINS AIGUS VERS LES SOINS CHRONIQUES 17 -- 3.4.1. Réduire la durée de séjour permet d’accroître la capacité en termes de nombre de séjours 17 -- 3.4.2. Moins de journées d’hospitalisation pour 2/3 des groupes de path

544 p., ill., SCIENTIFIC REPORT 33 -- INTRODUCTION AND BACKGROUND 33 -- 1 PROJECTED FUTURE TRENDS OF HOSPITAL USE IN BELGIUM 35 -- 1.1 INTRODUCTION 35 -- 1.2 TREND ANALYSIS 36 -- 1.3 DATA 37 -- 1.3.1 Population data 37 -- 1.3.2 Hospital data 39 -- 1.4 EVALUATION OF THE REPORT CANNOODT 40 -- 1.4.1 Projection model 41 -- 1.4.2 Comments on the research methodology 45 -- 1.4.3 Evaluation of the projection outcomes 46 -- 1.5 PROJECTION MODEL DEVELOPED FOR THE CURRENT STUDY 59 -- 1.5.1 Defining scope and concepts 61 -- 1.5.2 Rationale for statistical trend analysis 68 -- 1.5.3 Statistical trend model 70 -- 1.5.4 Projection outcomes 78 -- 1.6 INTRODUCTION RESULTS 80 -- 1.7 BASELINE FORECAST RESULTS OF THE PROJECTION MODEL 81 -- 1.7.1 Future need for hospital inpatient care 81 -- 1.7.2 Future need for hospital day care 104 -- 1.7.3 Capacity requirements for isolated categorical hospitals and foreign patients 112 -- 1.7.4 Summary of baseline forecast results 116 -- 1.8 PROJECTION RESULTS SCENARIO WITH ACCELERATED SUBSTITUTION TO DAY CARE 124 -- 1.8.1 Methodology 125 -- 1.8.2 Results 130 -- 1.9 PROJECTION RESULTS SCENARIO WITH ACCELERATED POPULATION AGEING 135 -- 1.9.1 Methodology 135 -- 1.9.2 Results 137 -- 2 HOSPITAL USE BY PATIENTS WITH DEMENTIA 145 -- 2.1 BACKGROUND AND AIM OF THE STUDY 145 -- 2.2 METHOD 147 -- 2.2.1 Literature review 147 -- 2.2.2 Analysis of Belgian hospital registry data 148 -- 2.3 RESULTS ON EPIDEMIOLOGICAL DATA 150 -- 2.3.1 Incidence/prevalence of dementia 150 -- 2.3.2 Hospital use by dementia patients 154 -- 2.4 RESULTS ON INTERVENTIONS TO REDUCE HOSPITAL USE BY DEMENTIA PATIENTS 162 -- 2.4.1 Strategies outside the hospital with an impact on hospital use 162 -- 2.4.2 Strategies in the hospital 164 -- 2.4.3 Strategies with regard to fall prevention 166 -- 2.5 DISCUSSION AND CONCLUSION 166 -- 3 ENGLAND 169 -- 3.1 BACKGROUND 169 -- 3.1.1 Country context 169 -- 3.1.2 Hospital classification 170 -- 3.1.3 Hospital capacity and use 170 -- 3.1.4 English hospitals underwen