Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2018

Patterns of care for patients with oesophageal cancer in Victoria: data prior to implementation of Optimal Care Pathways (#180)

Victoria White 1 , Brenton Baguley 1 , Michael Jefford 2 , Marita Reed 3 , Kathryn Whitfield 3 , Barry Curran 3 , Ahmad Aly 4 , Paul Cashin 5
  1. Deakin University, Burwood, VIC, Australia
  2. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
  3. Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
  4. Austin Health, Melbourne, Victoria, Australia
  5. Monash Health, Melbourne, Victoria, Australia

Aim: Low survival rates for oesophageal cancer (OC) have increased the focus on treatment pathways for this cancer. This study examines treatment of OC in Victoria prior to the implementation of Optimal Care Pathways (OCP) that aim to reduce care variations.

Methods:  A population-based cohort of patients diagnosed with OC between 1/1/2015 and 31/6/2016 was identified through the Victorian Cancer Registry. Trained research assistants attended each patient's treatment centre to extract details relating to patient demographics, symptoms, treatments and outcomes from their medical record. Chi-square analyses examined diagnostic and treatment differences between groups and non-parametric tests examined differences between groups for when distributions were not normal.

Results: To date, complete data for 291 of 507 eligible patients has been collected. 82% of patients [age (years), 71±12.0; 70% male] were symptomatic at diagnosis [dysphagia (69%); weight loss (52%)]. 25% were diagnosed with localised (T1-T3,N0,M0), 33% locally advanced (T4; T1-3,N1-3, M0) and 31% metastatic disease (M1). 58% were discussed at multidisciplinary meetings (MDM); less likely for patients >75 years (p<0.01) or metastatic disease (p=0.025). Median (quartile) time from diagnosis to MDM [17.0 days (7.0, 30.0)] and from MDM to first treatment [25.0 days; (10.5, 38.5)] were greater than OCP recommendations (both 14 days) and both intervals were shorter for metastatic [diagnosis-MDM (10 days); MDM-treatment (18.5 days)] than non-metastic [diagnosis-MDM (18.5 days); MDM-treatment (28.0 days]) disease (p<0.05). 9% of patients were enrolled in a clinical trial which was more common for those discussed at a MDM (15% vs 2%, p<0.01).   31% of localised disease had surgery with 3 cases (all ≥75 years) not having treatment. Of ambulant patients with locally advanced disease, 81% received chemotherapy and 30% had surgery. 52% of locally advanced patients having surgery had post-operative complications, with anastomatic-leak reported for 32%. For ambulant locally advanced disease, those ≥75 years were less likely to have chemotherapy (63% vs 90%, p<0.01) or surgery (7% vs 25%, p<0.01). 72% of metastatic patients received palliative chemo/radiotherapy with this less likely for ambulant patients ≥75 years (55%) than those < 75 (86%) (p<0.01). While dietitians (82%) were commonly seen by patients, other allied health professionals were less common with 55% seeing a physiotherapist, and 45% a social worker. Psychosocial screening was recorded for only 20% of patients which did not vary by disease stage or age but was more common for patients having chemotherapy/radiotherapy (25% vs 12, p<0.01). Of patients who had died (n=162), 60% had been referred to palliative care services.

Conclusion: Extended intervals between MDM-treatment, differences in MDM presentation by stage and variations in care by age suggest areas for improvement in OC treatment. Future work will determine if OCPs reduce care variations.