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

"Declarations Ethics approval and consent to participateAs stated in the main text of the manuscript,“Data were pseudonymized using pseudonymization procedures on the patient and the hospital level, respectively. Pseudonymization on both levels was conducted by WIdO. The data was encrypted for transfer and subsequently analyzed at the Center for Evidence-based Healthcare (ZEGV) of the TU Dresden, Germany. The WiZen study was approved by the ethics committee of the TU Dresden (approval number: EK95022019, IRB 00001473, OHRP IORG0001076). Data processing and analyses were conducted in line with the Declaration of Helsinki and the General Data Protection Regulation of the European Union.” Consent for publicationDoes not apply. Competing interestsVB, CB, JS, and OS work at a university hospital with certified cancer centers, and MR worked there in the past. In addition, they received funding from the Innovation Committee of the Federal Joint Committee during the conduct of the study. Unrelated to this study, JS reports institutional grants for investigator-initiated research from the German GBA, the BMG, BMBF, EU, Federal State of Saxony, Novartis, Sanofi, ALK, and Pfizer. He also participated in advisory board meetings as a paid consultant for Sanofi, Lilly, and ALK. Unrelated to this study, OS worked as a paid consultant for Novartis. He is also a member of the certification commission “Skin Cancer Centers” of the German Cancer Society and a member of the expert panel in the project "Development of Criteria for the Evaluation of Certificates and Quality Seals in Accordance with Sect. 137a (3) Sentence 2 Number 7 SGB V" for the Institute for Quality Assurance and Transparency in Health Care (IQTIG). The other authors declare that they have no conflict of interest. Competing interests VB, CB, JS, and OS work at a university hospital with certified cancer centers, and MR worked there in the past. In addition, they received funding from the Innovation Committee of the Federal Joint Committee during the conduct of the study. Unrelated to this study, JS reports institutional grants for investigator-initiated research from the German GBA, the BMG, BMBF, EU, Federal State of Saxony, Novartis, Sanofi, ALK, and Pfizer. He also participated in advisory board meetings as a paid consultant for Sanofi, Lilly, and ALK. Unrelated to this study, OS worked as a paid consultant for Novartis. He is also a member of the certification commission “Skin Cancer Centers” of the German Cancer Society and a member of the expert panel in the project "Development of Criteria for the Evaluation of Certificates and Quality Seals in Accordance with Sect. 137a (3) Sentence 2 Number 7 SGB V" for the Institute for Quality Assurance and Transparency in Health Care (IQTIG). The other authors declare that they have no conflict of interest."

"Funding Open Access funding enabled and organized by Projekt DEAL. The authors declare that the source of funding (the German Federal Joint Committee as part of the Innovationsfonds) did not have any influence on the research and the results of the WiZen study."

"The results presented here are part of the WiZen (Wirksamkeit der Versorgung in onkologischen Zentren/ Effectiveness of care in oncological centers) study, which was publicly funded by the German Federal Joint Committee (G-BA, Gemeinsamer Bundesausschuss) as part of the Innovationsfonds program to further develop the German healthcare system based on the standards and principles of evidence-based healthcare (funding number 01VSF17020). WiZen is a controlled cohort study based on data from the largest German statutory health insurance (AOK, Allgemeine Ortskrankenkasse), data from four clinical cancer registries, data about hospital certification status and hospital characteristics based on the mandatory, standardized quality reports of German hospitals. The main objective of the study was to compare certified cancer centers (“certified hospital group”) and non-certified hospitals (“non-certified hospital group”) in Germany regarding the survival of patients with at least one of eight cancer entities (colorectal, pancreatic, lung, prostate, breast, head and neck, brain cancer, and gynecological tumors), and to quantify possible survival differences in treatment between certified cancer centers and non-certified hospitals. The study includes a separate analysis of health insurance and cancer registry data, and a linkage resulting in a subset of data that covers as many confounders as possible. In this paper, we present separate analyses for colon (ICD-10 C18-C19) and rectal (ICD-10 C20) cancer using health insurance data as the main source of information. The study has been registered at ClinicalTrials.gov (ID: NCT04334239) and is reported in agreement with the STROBE requirements and the German Standard for Reporting of Secondary Data Analyses (STROSA) [, ]."