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National Trends in Utilization of Endoscopic Ultrasound for Gastric Cancer: a SEER-Medicare Study. J Gastrointest Surg 2016; 20:154-63; discussion 163-4. [PMID: 26553265 DOI: 10.1007/s11605-015-2988-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/10/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Accurate preoperative staging is important for patients with gastric cancer. This study identifies the rate of utilization of endoscopic ultrasound (EUS) and its associated factors in Medicare patients with gastric adenocarcinoma. METHODS The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was queried from 1996 to 2009 for patients with gastric cancer who underwent gastric resection. Analysis with univariate, multivariate, and Cochran-Armitage trend tests were performed. RESULTS In 5826 patients with gastric cancer with an average age of 76.9 ± 6.62 years, 59.1% had regionalized spread of cancer. EUS utilization increased significantly during the study period from 2.6% to 22% (p < 0.0001). EUS patients were more likely to be male, white, married, have higher education and income quartiles, and live in large metropolitan areas compared to non-EUS patients (p < 0.0001). Even after controlling for confounding factors, patients who underwent EUS were more likely to have >15 lymph nodes examined (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.04-1.53) and have the administration of both pre- and postoperative chemotherapy (OR 1.27, 95% CI 1.03-1.57). CONCLUSION EUS is currently under-utilized but increasing. Patients who underwent EUS (12.9%) were more likely to receive other NCCN-recommended care, including perioperative chemotherapy and adequate nodal retrieval.
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Trip AK, Stiekema J, Visser O, Dikken JL, Cats A, Boot H, van Sandick JW, Jansen EPM, Verheij M. Recent trends and predictors of multimodality treatment for oesophageal, oesophagogastric junction, and gastric cancer: A Dutch cohort-study. Acta Oncol 2015; 54:1754-62. [PMID: 25797568 DOI: 10.3109/0284186x.2015.1009638] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In recent years, evidence supporting multimodality treatment for oesophageal, oesophagogastric junction (OGJ), and gastric cancer has accumulated. This population-based cohort-study investigates trends and predictors of utilisation of multimodality treatment for oesophagogastric cancer in the Netherlands. PATIENTS AND METHODS Data were obtained from the Netherlands Cancer Registry regarding patients with oesophageal (n = 5450), OGJ (n = 2168) and gastric cancer (n = 6683) without distant metastases who had undergone R0 or R1 surgery diagnosed between 2000 and 2012. Follow-up was completed until February 2014. Preoperative/postoperative chemotherapy and/or radiotherapy combined with surgery were considered multimodality treatment. Logistic regression analysis was performed to analyse the association of age, gender, socioeconomic status, clinical T and N classification, hospital type, comprehensive cancer centre network region, and year of diagnosis, with multimodality treatment receipt. Additional analyses were performed to explore differences in trends of utilisation of multimodality treatment between academic and non-academic hospitals. RESULTS Multimodality treatment utilisation for oesophageal, OGJ and gastric cancer increased significantly to 90%, 85% and 56% in 2012, respectively. In oesophageal and OGJ cancer patients, preoperative chemoradiotherapy was most frequently administered (85% and 47% in 2012, respectively), and in gastric cancer patients preoperative chemotherapy (47% in 2012). Lower age, higher clinical T and N classification, and diagnosis in more recent years were significantly associated with more frequent multimodality treatment receipt. The adoption of most types of multimodality treatment in academic hospitals preceded non-academic hospitals by a year. CONCLUSION In the Netherlands, the utilisation of multimodality treatment for oesophagogastric cancer has significantly increased during the past decade, especially in oesophageal and OGJ cancer. Multimodality treatment utilisation was especially dependent on patient and tumour characteristics and year of diagnosis, but multimodality treatment trends seem to be related to the publication of landmark studies, participation in nationally running clinical trials, and hospital type, preceding national guidelines.
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Affiliation(s)
- Anouk K Trip
- a Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Jurriën Stiekema
- b Department of Surgery The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Otto Visser
- c Department of Registration & Research , Comprehensive Cancer Centre The Netherlands , Utrecht , The Netherlands
| | - Johan L Dikken
- a Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
- d Department of Surgery , Leiden University Medical Centre , Leiden , The Netherlands
| | - Annemieke Cats
- e Department of Gastroenterology and Hepatology The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Henk Boot
- e Department of Gastroenterology and Hepatology The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Johanna W van Sandick
- b Department of Surgery The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Edwin P M Jansen
- a Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Marcel Verheij
- a Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
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Stordeur S, Vlayen J, Vrijens F, Camberlin C, De Gendt C, Van Eycken E, Lerut T. Quality indicators for oesophageal and gastric cancer: a population-based study in Belgium, 2004-2008. Eur J Cancer Care (Engl) 2015; 24:376-86. [DOI: 10.1111/ecc.12279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 02/04/2023]
Affiliation(s)
- S. Stordeur
- Belgian Health Care Knowledge Centre; Belgium
| | - J. Vlayen
- Belgian Health Care Knowledge Centre; Belgium
| | - F. Vrijens
- Belgian Health Care Knowledge Centre; Belgium
| | | | | | | | - T. Lerut
- Department of Thoracic Surgery; UZ Leuven; Belgium
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Surveillance of Barrett's esophagus and mortality from esophageal adenocarcinoma: a population-based cohort study. Am J Gastroenterol 2014; 109:1215-22. [PMID: 24980881 DOI: 10.1038/ajg.2014.156] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/11/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Barrett's esophagus (BE) is associated with an increased risk of developing esophageal adenocarcinoma (EAC). Patients with a known diagnosis of BE are usually advised to participate in an endoscopic surveillance program, but its clinical value is unproven. Our objective was to compare patients participating in a surveillance program for BE before EAC diagnosis with those not participating in such a program, and to determine predictive factors for mortality from EAC. METHODS All patients diagnosed with EAC between 1999 and 2009 were identified in the nationwide Netherlands Cancer Registry. These data were linked to Pathologisch-Anatomisch Landelijk Geautomatiseerd Archief, the Dutch Pathology Registry. Prior surveillance was evaluated, and multivariable Cox proportional hazards regression analysis was performed to identify predictors for all-cause mortality at 2-year and 5-year follow-up. RESULTS In total, 9,780 EAC patients were included. Of these, 791 (8%) patients were known with a prior diagnosis of BE, of which 452 (57%) patients participated in an adequate endoscopic surveillance program, 120 (15%) patients in an inadequate program, and 219 (28%) patients had a prior BE diagnosis without participating. Two-year (and five-year) mortality rates were lower in patients undergoing adequate surveillance (adjusted hazard ratio (HR)=0.79, 95% confidence interval (CI)=0.64-0.92) when compared with patients with a prior BE diagnosis who were not participating. Other factors associated with lower mortality from EAC were lower tumor stage (stage I vs. IV, HR=0.19, 95% CI=0.16-0.23) and combining surgery with neoadjuvant chemo/radiotherapy (HR=0.66, 95% CI=0.58-0.76). CONCLUSIONS Participation in a surveillance program for BE, but only if adequately performed, reduces mortality from EAC. Nevertheless, it remains to be determined whether such a program is cost-effective, as more than 90% of all EAC patients were not known to have BE before diagnosis.
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Schønnemann KR, Mortensen MB, Bjerregaard JK, Fristrup C, Pfeiffer P. Characteristics, therapy and outcome in an unselected and prospectively registered cohort of patients with gastro-oesophageal cancer. Acta Oncol 2014; 53:385-91. [PMID: 23957622 DOI: 10.3109/0284186x.2013.820839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose was to examine characteristics, treatment and outcome in an unselected, prospectively registered complete population of patients with gastro-oesophageal adenocarcinoma cancer (GEA). METHODS All cases diagnosed with GEA between 2008 and 2009 in the Region of Southern Denmark (pop: 1,200,000) were registered. Patient characteristics, including performance status, stage and therapy, were retrieved from patient charts and used to compare sub-groups of patients. RESULTS Three hundred and thirty patients were registered as having GEA. Patients were divided into three clinical subgroups based on initial treatment option: group 1: patients with resectable GEA (n = 113); group 2: patients receiving first-line therapy (n = 107); group 3: patients receiving no tumour-directed therapy (n = 110). Median overall survival (95% CI) in the three groups was 36 months (25-not reached), 7.1 months (7-9) and 2.4 months (2-3), respectively. Seven percent of patients participated in clinical trials. CONCLUSION Among patients not amendable to resection, around 30% are candidates for three-drug combination chemotherapy. Age > 65 years was found not to be a poor prognostic factor for survival, giving the possibility of treating elderly patients in the future. Many patients (approx. 30%), however, never received cancer-directed therapy. In order to improve survival in the entire population, it is important that future trials also focus on this group of patients.
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Ahmed S, Iqbal N, Yadav S, Zaidi A, Ahmed O, Alvi R, Gardner D, Haider K. Time to Adjuvant Therapy and Other Variables in Localized Gastric and Gastroesophageal Junction (GEJ) Cancer (IJGC-D-13-00162). J Gastrointest Cancer 2014; 45:284-90. [DOI: 10.1007/s12029-014-9585-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Veisani Y, Delpisheh A, Sayehmiri K, Rahimi E. Demographic and histological predictors of survival in patients with gastric and esophageal carcinoma. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:547-53. [PMID: 24396572 PMCID: PMC3871740 DOI: 10.5812/ircmj.11847] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 05/26/2013] [Accepted: 06/08/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the possible influence of demographic and histological risk factors on the survival of patients with esophageal and gastric cancer. OBJECTIVES Based on the available registry and follow-up information, this study compares 1-5 year survival rate of gastric and esophageal cancer. PATIENTS AND METHODS Through a concurrent (prospective) cohort study, all 366 patients with definite diagnosis of esophageal and gastric cancer who had been hospitalized at the Towhid Hospital, Sanandaj city, Kurdistan province, western Iran during a five-year period from 2006 onwards were recruited. The survival time of patients stratified by this grouping method were analyzed by Kaplan-Meier analysis and Cox regression. RESULTS Amongst the 366 patients, 23 had esophageal adenocarcinoma, 94 esophageal squamous-cell carcinoma and 239 had gastric adenocarcinoma. Age at diagnosis (P = < 0.001), tumor grade (P = 0.008) and practice treatment (P = < 0.001) had significant associations with the variation of survival rates in patients with esophageal but not with gastric cancer. The five-year survival rates (by year) for esophageal cancer were 49%, 27%, 24%, 22% and 19%, respectively and for gastric cancer were 41%, 17%, 13%, 10% and 5.4%, respectively. CONCLUSIONS Major differences between these cancers were seen in the survival rates of patients and their incidence classified by sex. Age at diagnosis and histological types were prognostic factors for survival of patients with esophageal cancer but this wasn't the case for gastric cancer.
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Affiliation(s)
- Yousef Veisani
- Students' Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
- Department of Clinical Epidemiology, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Ali Delpisheh
- Department of Clinical Epidemiology, Ilam University of Medical Sciences, Ilam, IR Iran
- Prevention of Psychosocial Injuries Department, Research Centre, Ilam, IR Iran
- Corresponding author: Ali Delpisheh, Department of Clinical Epidemiology, Ilam University of Medical Sciences, Ilam, IR Iran. Tel/Fax: +98-8412227103, E-mail:
| | - Kourosh Sayehmiri
- Prevention of Psychosocial Injuries Department, Research Centre, Ilam, IR Iran
| | - Ezzatollah Rahimi
- Liver and Digestive Research Centre, Kurdistan University of Medical Sciences, Sanandaj, IR Iran
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Smithers BM, Fahey PP, Corish T, Gotley DC, Falk GL, Smith GS, Kiroff GK, Clouston AD, Watson DI, Whiteman DC. Symptoms, investigations and management of patients with cancer of the oesophagus and gastro‐oesophageal junction in Australia. Med J Aust 2010; 193:572-7. [DOI: 10.5694/j.1326-5377.2010.tb04064.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 08/03/2010] [Indexed: 12/20/2022]
Affiliation(s)
- Bernard M Smithers
- Upper GI and Soft Tissue Unit, Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD
| | - Paul P Fahey
- Queensland Institute of Medical Research, Brisbane, QLD
| | - Tracie Corish
- Queensland Institute of Medical Research, Brisbane, QLD
| | - David C Gotley
- Upper GI and Soft Tissue Unit, Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD
| | | | - Garett S Smith
- University of Sydney Northern Clinical School, Royal North Shore Hospital, Sydney, NSW
| | | | | | - David I Watson
- Department of Surgery, Flinders University, Adelaide, SA
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