Pattern of care for cancer of the oesophagus in a western population

Nguyen, Thuy My; Hummel, Richard; Bright, Tim; Thompson, Sarah K.; Törnqvist, Björn; Watson, David I.

doi:10.1111/ans.14685

Cited by 2 publications

(4 citation statements)

References 12 publications

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“…In addition to patients diagnosed with oesophageal cancer at BH or SJOGBH, our cohort included patients who were diagnosed elsewhere but received active treatment at these two hospitals, slightly skewing the proportions of those receiving an active treatment (including radiotherapy). Our overall rate of radiotherapy utilisation is similar to the South Australian result of 72%; however, this past study reported rates of 67% and 78% of radical and palliative intent patients receiving radiotherapy, respectively 11 . Differences in patient population or regional variation in practice may account for this.…”

Section: Discussionsupporting

confidence: 71%

“…Thirty per cent of our cohort had metastatic disease at diagnosis which is higher than the 22% reported among patients presented at the South Australian statewide gastrointestinal MDM 11 . Patients from regional areas, such as in our study, may present with later stage of disease.…”

Section: Discussioncontrasting

confidence: 55%

“…Most studies addressing oesophageal cancer management have focussed on particular subgroups of patients, such as those with surgically resectable disease or the elderly 8,9 . Few published studies describe the patterns of care across the spectrum of disease, 3,10–12 and results at the hospital level and in regional areas are rare 13,14 …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 71%

Section: Discussioncontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…In Australia, the 5‐year survival has only improved from 8–9% in the 1980s to 17% in 2017 . As the majority of individuals present with metastatic disease, or are unfit for surgical resection, <30% undergo surgery . Oesophagectomy is associated with significant risks, with 1970’s in‐hospital mortality rates averaging 29%, but declining to a still unacceptable 8.8% in the 1990s .…”

Section: Introductionmentioning

confidence: 99%

Hospital volume versus outcome following oesophagectomy for cancer in Australia and New Zealand

Meng

Bright

Woodman

et al. 2019

ANZ Journal of Surgery

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Background: Volume-outcome relationships for mortality following oesophagectomy have been demonstrated in Europe and the USA, but not in Australia or New Zealand. We determined whether higher volume hospitals achieve better outcomes following oesophagectomy in Australia and New Zealand. Methods: Administrative data for hospitals contributing data to the Health Roundtable were analysed. Hospitals performing oesophagectomy for cancer from July 2008 to June 2015 were grouped according to mean annual caseload: low (1-5), medium (6-11) and high (12+) volume. Univariate and multivariable analyses determined the impact of volume on 30-day and in-hospital mortalities, length of hospital stay and mechanical ventilation following surgery. Results: A total of 2252 patients underwent oesophagectomy in 65 hospitals. Sixty-eight percent (n = 44) were low-, 26% (n = 17) were medium-and 6% (n = 4) were high-volume hospitals. Seven hundred and sixty-two (34%) procedures were performed in low-, 1042 (46%) in medium-and 448 (20%) in high-volume hospitals. Overall in-hospital mortality was 3.1% and 30-day mortality was 2.1%. In-hospital mortality was lowest in high-volume hospitals; 1.6% versus 2.6% and 4.1% for low-and medium-volume hospitals (P = 0.02). Surgery in high-volume hospitals was shorter (32 min, P = 0.001), and patients were less likely to require post-operative ventilation (16.7% versus 25.3% and 28.0%, P < 0.001), although patients requiring ventilation in high-volume hospitals were ventilated for longer. Conclusions: A volume-outcome relationship was demonstrated, with overall better performance in higher volume hospitals. Colocation of oesophagectomies to hospitals that can demonstrate appropriate caseload should be considered.

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Pattern of care for cancer of the oesophagus in a western population

Abstract: Whilst approximately half of patients underwent treatment with curative intent, only a minority underwent surgery. Future efforts to improve survival outcomes for oesophageal cancer should address patients who are unfit for surgery and those presenting with metastatic disease.

Cited by 2 publications

References 12 publications

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

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

Hospital volume versus outcome following oesophagectomy for cancer in Australia and New Zealand

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