The Dutch Upper GI Cancer Audit: 2011-2014.

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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Hospital variation and the impact of postoperative complications on the use of perioperative chemo(radio)therapy in resectable gastric cancer. Results from the Dutch Upper GI Cancer Audit

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2018.01.008 ◽

2018 ◽

Vol 44 (4) ◽

pp. 532-538 ◽

Cited By ~ 4

Author(s):

M.G. Schouwenburg ◽

L.A.D. Busweiler ◽

N. Beck ◽

D. Henneman ◽

S. Amodio ◽

...

Keyword(s):

Gastric Cancer ◽

Postoperative Complications ◽

Upper Gi ◽

Hospital Variation ◽

Gi Cancer ◽

Radio Therapy ◽

Resectable Gastric Cancer ◽

Upper Gi Cancer ◽

The Impact

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Enrollment of esophago-gastric cancer patients in a clinical fast-track program and it’s affect on time to treatment and quality of life.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.180 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 180-180

Author(s):

Atuhani S. Burnett ◽

Jack Mouhanna ◽

Jose Ramirez-Garcialuna ◽

Emma Lee ◽

Julie Breau ◽

...

Keyword(s):

Quality Of Life ◽

Gastric Cancer ◽

Cancer Patients ◽

Severe Dysphagia ◽

Upper Gi ◽

Gi Cancer ◽

Pre Treatment ◽

Upper Gi Cancer ◽

Gastric Cancer Patients

180 Background: Esophago-gastric cancers are aggressive malignancies requiring numerous investigations to plan complex multi-modal therapy. The path from initial diagnosis to treatment can be associated with a long delay. This delay and complex patient trajectory may impact quality of life. Given the poor prognosis and highly symptomatic nature of upper GI cancer, a clear and timely access to treatment of crucial importance. We sought to determine the impact of a newly implemented streamlined and structure interdisciplinary pathway for newly diagnosed esophageal and gastric cancer on access times to treatment and quality of life (QoL). Methods: A streamlined pathway for patients referred to a high volume Upper GI Cancer clinic was generated with input from physicians, nutritionists, specialized nurses, and social workers. New diagnosis of esophageal or gastric cancer from 2014-16 were enrolled in this program and consenting patients completed serial QoL questionnaires (ESAS) at baseline, pre-treatment, 1 month post treatment. Dysphagia (DS) was quantified on a 5 point scale. Time intervals (days) were evaluated at various points between diagnosis and start of treatment (diagnosis, CT imaging, first visit with upper GI program, start of treatment). Data presented as median(IQR), * p < 0.05. Results: Of the 251 patients with Upper GI cancer, 153 (61%) consented to participate including 140 esophageal/EGJ and 13 gastric cancer patients. Clinical stage distribution was 17.9% I, 30.7% II, 42.6% III, 8.7% IV. Of the 82 Esoph/EGJ patients with completed QoL questionnaires, 15 (18.3%) patients had severe dysphagia (DS = 3-4) and were prioritized for treatment. Patients with severe dysphagia had reduced time from index endoscopy to treatment (29 (16.3-39.3) vs 43 (32.8-68.0)days)* and first Upper GI clinic to treatment (15 (8.0-23.0) vs 25 (21.0-36.0)*. ESAS surveys showed increased QoL for both patients with and without dysphagia from baseline to pre-treatment indicating that simply entry into the streamlined program improved QoL. Conclusions: Structured interdisciplinary investigative and treatment programs for upper GI cancers can expedite time to treatment and improve QoL.

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

Gastric Cancer ◽

10.1007/s10120-021-01225-1 ◽

2021 ◽

Author(s):

Marianne C. Kalff ◽

Anna D. Wagner ◽

Rob H. A. Verhoeven ◽

Valery E. P. P. Lemmens ◽

Hanneke W. M. van Laarhoven ◽

...

Keyword(s):

Esophageal Cancer ◽

Sex Differences ◽

Gastric Adenocarcinoma ◽

Relative Survival ◽

Cancer Surgery ◽

Male And Female ◽

Female Patients ◽

Upper Gi ◽

Gi Cancer ◽

Upper Gi Cancer

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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P-O01 A patient education video to support the management of post-gastrectomy / oesophagectomy syndromes

British Journal of Surgery ◽

10.1093/bjs/znab430.111 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Geoffrey Roberts ◽

Andrew Stone ◽

Nicola Sunderland ◽

Sam Grimes ◽

Frank Reimann ◽

...

Keyword(s):

Gastric Cancer ◽

Patient Education ◽

Hormone Secretion ◽

Eating Behaviour ◽

Physiological Basis ◽

Upper Gi ◽

Gut Hormone ◽

Patient Representatives ◽

Upper Gi Cancer ◽

Nutritional Strategies

Abstract Background Oesophagectomy and gastrectomy result in profound and life-long changes in eating behaviour and appetite, and significant post-prandial symptoms. Despite decades of research, and recent advantages in the understanding of gut physiology, medical approaches to post-resectional patient care remain limited. The mainstay of treatment is patient education. Using clinical and lab-based studies, we investigated the effects of altered gut hormone secretion in patients after surgery for oesophageal and gastric cancer. We then produced a partially animated patient information video to better equip our patients to manage their altered alimentation. Methods The scientific background to the video was previously presented at AUGIS, and published. Studies included examination of eating behaviour, post-prandial symptoms, glucose homeostasis, gut hormone profiles and intestinal transcriptomic / peptidomic changes in a cohort of patients after oesophagectomy and gastrectomy. The movie storyboard and script were written by a team of surgeons, dietitians, patient representatives, clinical scientists and communications specialists. The goal was to communicate the physiological basis of altered eating in post-operative patients and appropriate nutritional strategies. Results The video is now freely available on Vimeo at: https://vimeo.com/356892336 It is in routine use for pre- and post-operative patient education. Conclusions Multimedia patient education is a useful tool to help manage the late effects of upper GI cancer treatment.

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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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