Sex differences in tumor characteristics, treatment, and outcomes of gastric and esophageal cancer surgery: nationwide cohort data from the Dutch Upper GI Cancer Audit

Abstract Background Sex differences in clinicopathological characteristics, treatment, and postoperative outcomes of gastric and esophageal cancer are largely undefined. This study aimed to compare tumor and treatment characteristics and outcomes of gastric and esophageal cancer surgery between male and female patients. Methods Patients after elective surgery for primary esophageal (EAC) or gastric adenocarcinoma (GAC) registered in the Dutch Upper GI Cancer Audit between 2011 and 2016 were included. The primary endpoint, 5-year relative survival with relative excess risk (RER), i.e., adjusted for the normal life expectancy, was compared between male and female patients with EAC and GAC. Results In total, 4937 patients were included (75% male) with a mean age of 66 years. cT and cN-stages showed a similar distribution in male and female patients. In females, antrum GAC was more frequent (47% vs. 38%, p < 0.001). Female patients with EAC less frequently received neo-adjuvant treatment (OR = 0.60, 95% CI 0.38–0.96, p = 0.033). For GAC, less postoperative morbidity (33% vs. 38% p = 0.017) and less re-interventions (12% vs. 16%, p = 0.008) were observed in females, although they had inferior 5-year relative survival (49% vs. 56%, RER = 1.31, 95% CI 1.09–1.58, p = 0.004). No differences in relative survival of EAC were observed. Conclusions In addition to significant sex differences in tumor location, female patients with esophageal adenocarcinoma less frequently received neo-adjuvant therapy, and female patients with gastric adenocarcinoma had inferior relative survival. Further consideration and exploration of sex differences in surgical treatment and outcomes are necessary to improve tailored treatment and outcomes.

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Impact of Socio-Economic Deprivation on Mortality Rates after Upper GI Cancer Surgery

Endoscopy ◽

10.1055/s-2006-956827 ◽

2006 ◽

Vol 38 (11) ◽

Author(s):

Y Leigh ◽

J Seagroatt ◽

S Cole ◽

M Goldacre ◽

P McCulloch

Keyword(s):

Mortality Rates ◽

Cancer Surgery ◽

Economic Deprivation ◽

Upper Gi ◽

Gi Cancer ◽

Upper Gi Cancer

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The Dutch Upper GI Cancer Audit: 2011-2014.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.309 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 309-309 ◽

Cited By ~ 2

Author(s):

Linde A.D. Busweiler ◽

Bas P.L. Wijnhoven ◽

Mark I. van Berge Henegouwen ◽

Daniel Henneman ◽

Michel W.J.M. Wouters ◽

...

Keyword(s):

Gastric Cancer ◽

Esophageal Cancer ◽

Outcome Measures ◽

Postoperative Mortality ◽

Resected Specimen ◽

Valuable Insight ◽

Positive Trend ◽

Upper Gi ◽

Gi Cancer ◽

Upper Gi Cancer

309 Background: In 2011, the Dutch Upper GI Cancer Audit (DUCA) group started with a nationwide registration of all patients who underwent surgery for esophageal or gastric cancer. The aim of this study was to describe the initiation and implementation of the DUCA and to provide an overview of the results. Methods: The DUCA is part of the Dutch Institute for Clinical Auditing. It provides (surgical) teams with reliable, weekly updated, benchmarked information on process and (casemix-adjusted) outcome measures. A web-based registration was designed, based on a set of predefined quality measures. Results: Between 2011 and 2014, a total of 4672 patients with esophageal or gastric cancer was registered in the DUCA. Case ascertainment has approached 100% for patients registered in 2014. The percentage of patients with esophageal cancer starting treatment within 5 weeks after diagnosis significantly increased over time (33 to 41%) and the percentage of patients with a minimum of 15 lymph nodes in the resected specimen significantly increased for both esophageal cancer (50 to 73%) and gastric cancer (48 to 74%). Postoperative mortality decreased for patients with gastric cancer (8.0% in 2011 to 4.0% in 2014; p = 0.020) and remained stable (around 4%) for patients with esophageal cancer. Conclusions: Nationwide implementation of the DUCA has been successful. Results give a valuable insight in the quality of the surgical care for patients with esophageal or gastric cancer and show a positive trend for various process and outcome measures.

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Upper GI cancer surgery performed by a ‘breast surgeon’: Pros and Cons

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2007.07.048 ◽

2007 ◽

Vol 33 (9) ◽

pp. 1108-1109

Author(s):

M BALLAL ◽

T KELLY ◽

H SHARMA ◽

N EARDLY ◽

C MAGHEE ◽

...

Keyword(s):

Cancer Surgery ◽

Upper Gi ◽

Breast Surgeon ◽

Gi Cancer ◽

Pros And Cons ◽

Upper Gi Cancer

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1426P Gender differences in treatment characteristics and outcomes of esophagogastric cancer surgery - Data from the Dutch upper-GI cancer audit

Annals of Oncology ◽

10.1016/j.annonc.2020.08.1932 ◽

2020 ◽

Vol 31 ◽

pp. S902

Author(s):

M.C. Kalff ◽

A.D. Wagner ◽

R.H. Verhoeven ◽

V.E.P.P. Lemmens ◽

H.W.M. van Laarhoven ◽

...

Keyword(s):

Gender Differences ◽

Cancer Surgery ◽

Upper Gi ◽

Treatment Characteristics ◽

Gi Cancer ◽

Esophagogastric Cancer ◽

Upper Gi Cancer

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Common data items in seven European oesophagogastric cancer surgery registries: Towards a European Upper GI cancer audit (EURECCA Upper GI)

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2013.11.021 ◽

2014 ◽

Vol 40 (3) ◽

pp. 325-329 ◽

Cited By ~ 18

Author(s):

W.O. de Steur ◽

D. Henneman ◽

W.H. Allum ◽

J.L. Dikken ◽

J.W. van Sandick ◽

...

Keyword(s):

Cancer Surgery ◽

Upper Gi ◽

Gi Cancer ◽

Upper Gi Cancer ◽

Oesophagogastric Cancer

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Palliation of Upper GI Cancer

Encyclopedia of Pain ◽

10.1007/978-3-642-28753-4_101665 ◽

2013 ◽

pp. 2790-2790

Keyword(s):

Upper Gi ◽

Gi Cancer ◽

Upper Gi Cancer

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P-OGC66 Mental Health and Wellbeing Services for Patients with Upper GI Cancer

British Journal of Surgery ◽

10.1093/bjs/znab430.194 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Claire Coleman ◽

Wendy Hickey ◽

Cathy White

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Well Being ◽

Verbal Information ◽

Patient Cohort ◽

Upper Gi ◽

Gi Cancer ◽

Number Of Patients ◽

Upper Gi Cancer

Abstract Background Cancer related distress has a major impact on quality of life. The psychosocial needs of patients post an oesophagectomy are significant and exacerbate the physical burden. The Upper GI MDT at our hospital aim to provide holistic patient centred care that equips patients mentally and physically for their treatment pathway. Formal or structured pyschoncology services are not routinely available to our patient cohort. The aim of the audit undertaken was to assess awareness of and subsequent engagement with available mental health services in patients undergoing a curative resection for oesophagogastric cancer. Methods Patients who underwent either a gastrectomy or oesophagectomy in the Upper GI Centre between Nov 2018 and May 2019 were included. They each received a questionnaire to complete anonymously. Responses were via prepaid post. Responses were collated and analysed. Results 36 questionnaires sent out with 21 patients responding (Response rate 58%). Average age:69 (age range 40-84). 18 of the 21 responses were male Time diagnosed with cancer: 57% were between 12 to 18 months post diagnosis and 43% between 6 to 11 months. Source of Information received: 43% reported verbal information provided and 38% reported written information was provided Current engagement with Mental Health Services: National, Community, and Exercise programmes were used by a very small number of patients - 6 in total out of 21 respondents Reasons for not engaging with Mental Health Services responses included ‘Not being interested or required' to ‘fearful' ‘No knowledge of service' to ‘Cant remember ' or ‘Plans to engage' 93% of respondents would recommend use of wellbeing or mental health services to someone with a diagnosis of an Upper GI Cancer Suggestions for improvements varied from use of information packs, information on life post op and more guidance needed surrounding availability of current mental health supports Conclusions Psychosocial issues need to be addressed and there is a huge deficit in current service provision. Current service is not meeting service user needs and not empowering patients how best to manage mental burden and thus contribute to maximising treatment outcomes. National Cancer Strategy acknowledges lack of access for cancer patients to pyschoncology services. The Cancer Centre is awaiting appointment of a Pyschoncology Consultant and Team in the coming months. The Upper GI MDT will seek access to this service once available for their patient cohort. In interim use limited national and community resources available. Provide education to wider team members to standardise approach providing both written and verbal information on available mental health and well being services, embed mental health awareness into daily practice with encouragement for early patient intervention if cancer related distress evident. Re Audit after introduction of these measures.

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