{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:57:42Z","timestamp":1791291462395,"version":"4.3.0"},"reference-count":28,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,26]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Concentration of care and collaborations between hospitals increasingly reorganise oncological care into Comprehensive Cancer Networks (CCNs), aiming to improve care outcomes and reduce costs. This study aims to evaluate the effect of four CCNs on healthcare cost and outcomes for patients with colon or pancreatic cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study based on claims data in the Netherlands. Data included patient characteristics, health insurance claims and healthcare activities. All costs were indexed to Euro 2023. We performed propensity score matching per CCN and applied regression models with a difference-in-difference design, adjusting for non-linear trends before the start of a CCN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted within the Dutch healthcare system, analysing claims data representative of hospital-based cancer care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 92\u2009309 patients with colon cancer and 25\u2009630 patients with pancreatic cancer were included. Patients were identified through health insurance claims between January 2013 and June 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Implementation of four CCNs, which included structured collaboration between healthcare organisations. Follow-up duration was 2 years post-diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Primary outcomes included 2-year oncological healthcare costs and 2-year mortality rate. Secondary outcomes involved care process indicators: referral rates and double diagnostics (an identical diagnostic activity performed within 4\u2009weeks after referral to a secondary hospital).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For colon cancer, one CCN showed a significant decrease in 2-year oncological costs (\u2212\u20ac1899). One CCN showed a significant decrease in referrals (\u22123.6%) and one a significant increase (+4.4%). No significant effect on 2-year mortality and double diagnostic activities was found. For pancreatic cancer, one CCN showed a significant decrease in 2-year oncological costs (\u2212\u20ac3747) and one CCN showed a significant increase in double diagnostic activities (+8.6%). No significant effect on referrals and 2-year mortality was found.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CCNs do not consistently reduce costs or affect referral patterns or redundant diagnostics. No impact on mortality was found. Additional insights into determinants of CCN success are required before broad implementation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-100070","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T14:45:25Z","timestamp":1769697925000},"page":"e100070","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive Cancer Networks in the Netherlands: how do they affect quality and costs of care for colon or pancreatic cancer? A retrospective cohort study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0317-4458","authenticated-orcid":false,"given":"Cilla E J","family":"Vrinzen","sequence":"first","affiliation":[{"name":"IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niek","family":"Stadhouders","sequence":"additional","affiliation":[{"name":"IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiko J","family":"Bloemendal","sequence":"additional","affiliation":[{"name":"Radboudumc Afdeling Medische Oncologie, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Hayen","sequence":"additional","affiliation":[{"name":"IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands"},{"name":"Menzis, Wageningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Reitsma","sequence":"additional","affiliation":[{"name":"Zorgverzekeraars Nederland, Zeist, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel","family":"ten Hove","sequence":"additional","affiliation":[{"name":"Vektis, Zeist, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4198-2448","authenticated-orcid":false,"given":"Patrick P T","family":"Jeurissen","sequence":"additional","affiliation":[{"name":"IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias A W","family":"Merkx","sequence":"additional","affiliation":[{"name":"IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands"},{"name":"Netherlands Comprehensive Cancer Center, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosella P M G","family":"Hermens","sequence":"additional","affiliation":[{"name":"IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"2026100605250448000_16.1.e100070.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21731"},{"key":"2026100605250448000_16.1.e100070.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0195673","article-title":"What drives centralisation in cancer care?","volume":"13","author":"Kilsdonk","year":"2018","journal-title":"PLoS ONE"},{"key":"2026100605250448000_16.1.e100070.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(22)00398-9"},{"key":"2026100605250448000_16.1.e100070.4","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.ejso.2021.07.023","article-title":"Impact of nationwide centralization of oesophageal, gastric, and pancreatic surgery on travel distance and experienced burden in the Netherlands","volume":"48","author":"Luijten","year":"2022","journal-title":"Eur J Surg Oncol"},{"key":"2026100605250448000_16.1.e100070.5","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/j.healthpol.2018.07.002","article-title":"Centralisation of cancer surgery and the impact on patients\u2019 travel burden","volume":"122","author":"Versteeg","year":"2018","journal-title":"Health Policy"},{"key":"2026100605250448000_16.1.e100070.6","unstructured":"Taskforce Oncologie . 2015\/2020 koersboek oncologische netwerkvorming."},{"key":"2026100605250448000_16.1.e100070.7","unstructured":"Stichting Oncologische Samenwerking (SONCOS) . 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