Oesophageal cancer treatment patterns, timeliness of care and outcomes in the Loddon Mallee region of Victoria: A retrospective cohort study

Abstract

Introduction Few studies have investigated oesophageal cancer care in regional areas. This study aimed to describe treatment patterns for oesophageal cancer in a regional area, and to identify factors associated with radiotherapy utilisation, timeliness of care, and death. Methods In a retrospective cohort study, medical records were reviewed to source data on all patients diagnosed with and/or treated for oesophageal cancer at two regional Victorian hospitals over July 2015–June 2018. Cox proportional hazards regression was employed to identify factors associated with time from diagnosis to death while binary logistic regression was used to identify factors associated with radiotherapy utilisation and treatment within 28 days of diagnosis – a time frame derived from the relevant optimal care pathway. Results Of 95 patients, 72% had radiotherapy, 32% received any treatment within 28 days, and 78% died over a median time of nine months. Odds of not receiving radiotherapy were decreased (odds ratio [OR] = 0.26, 95% confidence interval [CI] = 0.08–0.87) for histology other than adenocarcinoma. Odds of timely care were increased for any palliative radiotherapy (OR = 3.47, 95% CI = 1.15–10.5) and decreased for older age (OR = 0.95, 95% CI = 0.91.0.999). Hazard of death was elevated for stage IV disease (hazard ratio [HR] = 2.73, 95% CI = 1.64–4.54) and reduced for radical intent (HR = 0.27, 95% CI = 0.15–0.48). Conclusion Nearly three‐quarters of regional oesophageal cancer patients had radiotherapy while approximately one‐third received any treatment within the recommended 28 days. Any palliative radiotherapy and younger age were associated with timely treatment. Future studies could further investigate factors related to timely oesophageal cancer care.

Optimal cancer care pathways – the ideal versus reality for patient-centric cancer care during COVID-19

“…These results are the first known publication in Australia benchmarking performance against the nationally endorsed OCPs for multiple different tumour subsites. [13][14][15][16] These results demonstrate that there is overall poor compliance by all tumour subsites, with inconsistency in performance of individual components. Despite being a single institution study, the results and implications are likely to be applicable to most cancer services across Australia.…”

“…To reduce the impact of COVID-19 on diagnosis, pathways have also been adjusted in some countries, allowing primary care physicians increasing access to intervention and diagnostic investigations. 28 Despite this being the first published study that benchmarks performance against multiple different OCPs, [13][14][15][16] there are several limitations, which relate to the fundamental issues discussed above. Firstly, given the complex nature of the diagnostic pathway, mainly conducted in the private health sector with no data linkage between primary and specialist health care, this component of the OCP prior to MDM discussion was excluded from this study.…”

“…This is the only study in Australia that has assessed OCP compliance for multiple different tumour subsites, over a given period of time. [13][14][15][16]…”