Centralization of complex treatments for cancer and vascular diseases in the Netherlands

On March 26, 2025, the Dutch Healthcare Institute (ZIN) announced new standards for vascular surgery and cancer treatment. These standards were developed during the Round Tables for Concentration & Distribution of Oncology and Vascular Surgery based on the Integral Care Agreement (Integraal Zorgakkoord, IZA) by patient organizations, healthcare providers, hospitals, and health insurers. The objective of the Integral Care Agreement is to ensure that healthcare remains reasonable, accessible, and affordable for the future. 

Starting in 2026, 18 complex treatments for cancer and vascular diseases will only be performed in hospitals that consistently demonstrate a high volume of such procedures. This result stems from national agreements establishing minimum procedural thresholds for hospitals, referred to as volume standards.

Examples of complex treatments for cancer and vascular diseases include radiotherapy for head and neck cancer, lung cancer, gastroesophageal cancer, and kidney cancer, complex endovascular interventions for aortic aneurysm, endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic cancer, oncological endoscopic resections for gastroesophageal cancer, pancreatic resections, regardless of diagnosis, and lung resections in lung cancer.

In November 2025, the seven regions reached agreements on the centralization of complex surgical care for cancer and vascular diseases. For each region, an overview is available of the treatments being provided in which hospitals, as well as which hospitals are not or no longer providing them. 

These centralization agreements will take effect on January 1, 2026. However, hospitals will have one year to make all necessary arrangements. The new distribution of care will take effect on January 1, 2027.

See the full details in Dutch here.

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