For the first time in Belgium, care pathways for patients with glioma, an often-aggressive brain tumour, were investigated. The study performed by the Belgian Cancer Registry demonstrates that the quality of care is generally good, but there is room for improvement, for example in imaging and timely follow-up treatment. The study also reveals that treatment in hospitals with larger patient volumes is associated with a slightly improved survival for patients with glioblastoma, a type of glioma with a very poor prognosis.
Approximately 730 patients in Belgium are diagnosed annually with glioma, a specific type of brain tumor. The majority (73%) are diagnosed with glioblastoma, a type of glioma with a very low survival probability. Sixty percent of patients with glioblastoma die within a year of diagnosis.
For the first time in Belgium, the Belgian Cancer Registry (BCR) evaluated quality of care for patients with glioma. The study was carried out in collaboration with Dr. Dimitri Vanhauwaert (Ghent University) and with financial support from the Foundation against Cancer. The focus of the study was on diagnosis, treatment, patient follow-up, and clinical outcomes such as survival. Additionally, an association between the number of patients treated in each hospital and the survival probability was evaluated. This study was based on cancer registry data, including information from pathology reports, and linked to health insurance data.
The results indicated that the quality of care in Belgium for patients diagnosed with glioma during the period 2016-2019 was generally good but also revealed areas for improvement. MRI imaging was often insufficiently used for accurate diagnosis. Postoperatively, MRI imaging was underutilized to assess the outcome of tumor removal, detect complications in a timely manner, and determine the further treatment plan. Additionally, many patients started adjuvant therapy (i.e., chemotherapy and radiotherapy after surgery) more than six weeks after surgery, which is considered too late according to clinical guidelines. Notably, care was highly dispersed across Belgian hospitals, most of which only treated a small number of patients with glioma annually.
"The results of this study are very important." said Dr. Veronique Le Ray, Medical Director of the Foundation against Cancer. "They provide a basis for mapping and further monitoring the quality of care for patients with glioma. This contributes to better care for future patients."
The study also specifically highlighted the unfavorable prognosis for patients with glioblastoma. Twelve percent of patients died within 30 days after biopsy, compared to 5% of patients who underwent surgical removal of the tumor. One year after the procedure, the survival probability for patients who underwent biopsy was only 22%, compared to 49% of patients for whom the tumor was surgically removed. After two years, these probabilities declined further, to 8% and 21%, respectively. Notably, the risk of dying in the first months after the procedure was slightly lower for patients who had surgery in hospitals that performed a higher number of glioma surgeries annually (25 to 30 surgeries per year).
This study is an excellent starting point to monitor and improve care for patients with glioma. All hospitals involved in the diagnosis and treatment of glioma received an individual feedback report with their results. This allows hospitals to compare their results with the (anonymized) results of other hospitals and with the national average and invites reflection upon their own practices and organization of care.
More information can be found in the following scientific articles:
- Quality indicators in neuro-oncology: Review of the literature and development of a new quality indicator set for glioma care through a two-round Delphi survey | Belgian Cancer Registry
- Cancer registration, molecular marker status and adherence to the WHO 2016 classification of pathology reports for glioma diagnosed during 2017-2019 in Belgium | Belgian Cancer Registry
- Measuring the diagnostic management and follow-upimaging for glioma patients across Belgian hospitalsbetween 2016 and 2019 | Belgian Cancer Registry
- Association of hospital volume with survival but not with postoperative mortality in glioblastoma patients in Belgium | Belgian Cancer Registry
- Vanhauwaert D, Vanschoenbeek K, Lombard A , Liefhooghe N, Lammens M, Dedeurwaerdere F, Whenham N, De Gendt C, Boterberg T, De Vleeschouwer S. Patterns and Quality of therapeutic care for Glioma: a population-based study in Belgium between 2016 and 2019. (Submitted)
A public report with detailed figures is available on the Belgian Cancer Registry website:
