SP5.1.9 Why are curative treatment rates so low for stage I/II Oesophago-gastric cancer in the West of Scotland?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Khurram Khan ◽  
Lewis Gall ◽  
Matthew Forshaw
Keyword(s):  
Performance Indicators ◽  
Stage I ◽  
Electronic Records ◽  
Curative Treatment ◽  
Newly Diagnosed ◽  
The West ◽  
Curative Intent ◽  
Quality Performance ◽  
Synchronous Cancers ◽  
Index Of Multiple Deprivation

Abstract Aims Over the last decade, quality performance indicators (QPIs) have been used to drive improvements in cancer care in Scotland. QPI-11 targets curative treatment rates for oesophago-gastric (OG) cancer and this target has been consistently missed. This study aimed to investigate why patients with potentially curable Stage I and II OG cancer did not receive curative treatment. Methods The West of Scotland MCN database was interrogated for patients with newly diagnosed stage I and II OG cancer between January 2018 and December 2019 to identify those patients who did not have curative treatment. Electronic records were then analysed. Results 81 patients (mean age of 79.3 ± 8.9 years; 41 (50.6%) female) were identified. Median Scottish Index of Multiple Deprivation was 3 (IQR 1-7). There were 46 (56.8%) oesophageal cancers, 49 (60.5%) adenocarcinomas and 63 (77.8%) were Stage II cancers. Formal CPEX fitness was assessed in only 6 patients (7.4%). Reasons for curative treatment not being received were as follows: not clinically fit (n = 69 (85.2%)); patient declined curative treatment (n = 7 (8.6%)); disease progression (n = 3 (3.7%)) and identification of synchronous cancers (n = 2 (2.5%)). 61 patients (75.3%) are deceased at the time of analysis, with a median time from MDT discussion to death of 6 (IQR 2-11.5) months. Conclusions Lack of fitness for radical treatment is the predominant reason for Stage I and II OG cancer patients in the West of Scotland not being treated with curative intent. This may be related to the previously described “West of Scotland” effect on health comorbidities.

scholarly journals 973 Why Are Curative Treatment Rates So Low for Stage I/II Oesophago-Gastric Cancer in The West of Scotland?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Khan ◽  
L Gall ◽  
M Forshaw
Keyword(s):  
Performance Indicators ◽  
Stage I ◽  
Electronic Records ◽  
Curative Treatment ◽  
Newly Diagnosed ◽  
The West ◽  
Curative Intent ◽  
Quality Performance ◽  
Synchronous Cancers ◽  
Index Of Multiple Deprivation

Abstract Aim Over the last decade, quality performance indicators (QPIs) have been used to drive improvements in cancer care in Scotland. QPI-11 targets curative treatment rates for oesophago-gastric (OG) cancer and this target has been consistently missed. This study aimed to investigate why patients with potentially curable Stage I and II OG cancer did not receive curative treatment in the West of Scotland. Method The West of Scotland MCN database was interrogated for patients with newly diagnosed stage I and II OG cancer between January 2018 and December 2019 to identify those patients who did not have curative treatment. Electronic records were then analysed. Results 81 patients (mean age of 79.3 ± 8.9 years; 41 (50.6%) female) were identified. Median Scottish Index of Multiple Deprivation was 3 (IQR 1-7). There were 46 (56.8%) oesophageal cancers, 49 (60.5%) adenocarcinomas and 63 (77.8%) were Stage II cancers. Formal CPEX fitness was assessed in only 6 patients (7.4%). Reasons for curative treatment not being received were as follows: not clinically fit (n = 69 (85.2%)); patient declined curative treatment (n = 7 (8.6%)); disease progression (n = 3 (3.7%)) and identification of synchronous cancers (n = 2 (2.5%)). 61 patients (75.3%) are deceased at the time of analysis, with a median time from MDT discussion to death of 6 (IQR 2-11.5) months. Conclusions Lack of fitness for radical treatment is the predominant reason for Stage I and II OG cancer patients in the West of Scotland not being treated with curative intent. This may be related to the previously described “West of Scotland” effect on health comorbidities.

scholarly journals P-OGC77 Why curative treatment rates are so low for stage I/II Oesophago-gastric cancer in the West of Scotland? – A five year review

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Khurram Khan ◽  
Lewis Gall ◽  
Gillian Miller ◽  
Andrew Macdonald ◽  
Carol Craig ◽  
...  
Keyword(s):  
Performance Indicators ◽  
Stage I ◽  
Electronic Records ◽  
Curative Treatment ◽  
Newly Diagnosed ◽  
The West ◽  
Curative Intent ◽  
Quality Performance ◽  
Synchronous Cancers ◽  
Index Of Multiple Deprivation

Abstract Background Over the last decade, quality performance indicators (QPIs) have been used to drive improvements in cancer care in Scotland.  QPI-11 targets curative treatment rates for oesophago-gastric (OG) cancer and this target has been consistently missed.  This study aimed to investigate why patients with potentially curable Stage I and II OG cancer did not receive curative treatment.  Methods The West of Scotland MCN database was interrogated for patients with newly diagnosed stage I and II OG cancer between January 2015 and December 2019 to identify those patients who did not have curative treatment.  Electronic records were then analyzed and the reason for the non curative treatment recorded. Results 260 patients (mean age 78.3 ± 9 years; 114 (43.8%) female) were identified. Median Scottish Index of Multiple Deprivation was 4 (IQR 2-7).   There were 159 (61.2%) oesophageal cancers, 196 (75.4%) adenocarcinomas and 174 (66.9%) were Stage II cancers.  Formal CPEX fitness was assessed in only 20 patients (7.7%).  Reasons for curative treatment not being received were as follows: not clinically fit (n = 216 (83.1%)); patient declined curative treatment (n = 17 (6.5%)); disease progression (n = 16 (6.2%)) and identification of synchronous cancers (n = 9 (3.5%)). Conclusions Lack of fitness for radical treatment is the predominant reason for Stage I and II OG cancer patients in the West of Scotland not being treated with curative intent.  This may be related to the previously described “West of Scotland” effect on health comorbidities.

scholarly journals Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?

2020 ◽  
Author(s):  
Ross Lawrenson ◽  
Chunhuan Lao ◽  
Leonie Brown ◽  
Lucia Moosa ◽  
Lynne Chepulis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Hazard Ratio ◽  
Stage I ◽  
Curative Treatment ◽  
Curative Surgery ◽  
Early Stage Lung Cancer ◽  
Curative Intent ◽  
Receive Treatment ◽  
Stage Lung Cancer

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.

TP6.2.16General practitioner compliance with Scottish cancer referral guideline for Oesophago-gastric cancer

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Rongkagorn Chuntamongkol ◽  
Khurram Khan ◽  
Catherine McCollum ◽  
Matthew Forshaw
Keyword(s):  
Gastric Cancer ◽  
Primary Care ◽  
Electronic Records ◽  
Newly Diagnosed ◽  
Optimal Outcome ◽  
National Guidelines ◽  
Education And Awareness ◽  
The Mean ◽  
Index Of Multiple Deprivation ◽  
Timely Referral

Abstract Aims The outcome of oesophago-gastric cancer is often poor. Timely referral of suspected cancer is essential for early diagnosis and optimal outcome. This study aims to audit the General Practitioners (GPs) compliance with the Scottish referral guidelines for suspected oesophago-gastric cancer. Methods A retrospective cohort study of all newly diagnosed oesophago-gastric cancers who were referred from the primary care and discussed in a single regional MDT was performed between October 2019 and September 2020. Electronic records were interrogated and symptomatology audited against the Scottish cancer referral guidelines. Results Of the 349 patients, 227 (65.0%) were referred from the primary care. 150 (66.1%) were male and the mean age was 69.5 ± 10.9 years. Mean Scottish Index of Multiple Deprivation was 5 ± 3. 149 (65.6%) had dysphagia and/or odynophagia and 181 (79.7%) were oesophageal cancers. 67 (29.5%) were T4 disease and 87 (38.3%) were metastatic at presentation. Urgency of referral was: 25 (11.0%) routine, 54 (23.7%) urgent and 148 (65.2%) Urgent Suspicion of Cancer (USOC). 192 (84.6%) patients qualified to be referred as USOC, of these 138 (71.9%) were actually referred as USOC. Of the 35 (15.4%) patients who did not qualify for the USOC referral, 10 (28.6%) patients were referred as USOC. The sensitivity was 71.9% and specificity 71.4%. Conclusions GP compliance with the adherence with the National guidelines remains a barrier in the USOC in oesophago-gastric cancer. Further GP education and awareness is required to improve their compliance.

scholarly journals Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?

2020 ◽  
Author(s):  
Ross Lawrenson ◽  
Chunhuan Lao ◽  
Leonie Brown ◽  
Lucia Moosa ◽  
Lynne Chepulis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Stage I ◽  
Curative Treatment ◽  
Curative Surgery ◽  
Early Stage Lung Cancer ◽  
Curative Intent ◽  
Receive Treatment ◽  
To Receive ◽  
Stage Lung Cancer

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.

scholarly journals Real world duration of curative intent breast, colorectal, non-small cell lung, and prostate cancer treatment

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Selina K. Wong ◽  
Jeremy Hamm ◽  
Aria Shokoohi ◽  
Colleen E. McGahan ◽  
Cheryl Ho
Keyword(s):  
Prostate Cancer ◽  
Cancer Treatment ◽  
Median Duration ◽  
Real World ◽  
Recovery Time ◽  
Cancer Survival ◽  
Multimodality Treatment ◽  
Stage I ◽  
Curative Treatment ◽  
Curative Intent

Abstract Background Advances in curative treatment for breast, colorectal, NSCLC and prostate cancer have led to improvements in cancer survival. Cancer treatment and recovery time can vary depending on the recommended modalities and intensity of therapy. Our objective was to determine the current real world duration of curative treatments for the four common cancers. Methods A retrospective review was completed of patients referred to BC Cancer from 2010 to 2016, ≤ 65 years old, newly diagnosed with stage I-III breast, colorectal, NSCLC or prostate cancer who received curative intent treatment. Information was collected on baseline characteristics, date of diagnosis, surgery, type, duration and intent of both radiotherapy and chemotherapy. Results In total, 22,275 patients were included: 55.7% breast, 22.4% colorectal, 9.2% NSCLC, 12.7% prostate cancer. Stage I/II/III at diagnosis: breast 47.2/38.7/14.1%, colorectal 26.5/30.1/43.5%, NSCLC 46.5/18.1/35.4%, prostate 7.7/62.9/29.4%. Patients treated with definitive surgery only: breast 35.9%, colorectal 58%, NSCLC 52.2%, prostate 40.1%. The median duration of multimodality treatment was breast 24.6 weeks, colorectal 26.7 weeks, NSCLC 9.1 weeks, and prostate 6.0 weeks. Conclusions Approximately half of patients who undergo curative cancer treatment require definitive radiotherapy or multimodality treatment. The median duration of therapy for the most commonly treated cancers ranged from 6.0–26.7 weeks. Multimodality curative treatment can be prolonged for selected cancers when accounting for the duration of adjuvant chemotherapy and radiotherapy and recovery time between modalities.

scholarly journals Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?

2019 ◽  
Author(s):  
Ross Lawrenson ◽  
Chunhuan Lao ◽  
Leonie Brown ◽  
Lucia Moosa ◽  
Lynne Chepulis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Hazard Ratio ◽  
Stage I ◽  
Curative Treatment ◽  
Curative Surgery ◽  
Early Stage Lung Cancer ◽  
Curative Intent ◽  
Receive Treatment ◽  
Stage Lung Cancer

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have NSCLC, had poorer lung function and were more likely to have an ECOG status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). SABR has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.

scholarly journals Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?

2020 ◽  
Author(s):  
Ross Lawrenson ◽  
Chunhuan Lao ◽  
Leonie Brown ◽  
Lucia Moosa ◽  
Lynne Chepulis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Stage I ◽  
Curative Treatment ◽  
Curative Surgery ◽  
Early Stage Lung Cancer ◽  
Curative Intent ◽  
Receive Treatment ◽  
To Receive ◽  
Stage Lung Cancer

Abstract Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. A key question was whether indigenous Māori patients were less likely to receive treatment. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have non-small cell lung cancer (NSCLC), had poorer lung function and were more likely to have an ECOG performance status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). Stereotactic ablative body radiotherapy (SABR) has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). After adjustment we could find no difference in treatment and survival between Māori and non-Māori. Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.

Primary Surgical Treatment in Very Advanced (T4b) Oral Cavity Squamous Cell Carcinomas

2021 ◽  
pp. 019459982098435
Author(s):  
Evan J. Patel ◽  
Jamie R. Oliver ◽  
Alec Vaezi ◽  
Zujun Li ◽  
Michael Persky ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Propensity Score ◽  
Oral Cavity ◽  
Squamous Cell ◽  
Multivariable Analysis ◽  
Group Versus ◽  
Curative Treatment ◽  
National Cancer Database ◽  
Curative Intent ◽  
Historical Cohort

Objectives To describe patterns of primary surgical treatments in patients with T4b oral cavity squamous cell carcinoma (OCSCC). Study Design Historical cohort study. Setting National Cancer Database. Methods Review of the National Cancer Database between 2004 and 2017 for all T4b OCSCCs. Only patients with curative treatment methods were included in the survival analysis. Surgical and nonsurgical outcomes were compared by multivariable and propensity score matching analysis. Results A total of 1515 cases of T4b OCSCC were identified. A minority of patients (n = 363, 24.0%) underwent curative treatment; among these, 206 (56.7%) underwent primary surgery. Median length of follow-up was 24 months. The 90-day mortality of patients who underwent surgical treatment was 1.0%. The 2-year survival was higher for patients who underwent surgery + chemoradiotherapy (CRT) as compared with CRT (64.6% vs 45.2%, P < .001). On multivariable analysis, surgery + CRT was associated with longer survival. In a propensity score–matched cohort of 312 patients, 2-year survival remained higher in the surgical group versus the nonsurgical group (59.4% vs 45.5%, P = .02). Among patients who underwent surgery + CRT, there was no difference in 2-year survival between clinical T4a and T4b (59% vs 64.6%, P = .20). Conclusions A minority of patients with T4b OCSCC undergo treatments with curative intent. A subset of patients underwent primary surgical treatment, which was associated with longer survival. The T4b classification might entail a heterogenous group, and further studies in revision of this classification might be justified.

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