Oesophageal and Gastric Cancer: optimising care and outcomes in changing clinical practice

Improving quality of care for patients with oesophageal and gastric cancer is a major challenge as the incidence is relatively low and most patients have an advanced disease at time of diagnosis. The studies presented in this thesis aimed to give more insight in the provided care and outcomes for patients with oesophageal and gastric cancer in daily clinical practice. It was shown that the hospital of diagnosis influences the probability to receive curative treatment for oesophageal and gastric cancer. Moreover, its impact on survival indicates that treatment decision-making may be improved for patients with these malignancies. It was also shown that survival improved for patients with oesophageal cancer the last 26 years, probably due to the introduction of neoadjuvant chemoradiotherapy and centralisation of surgery. Survival of patients with gastric cancer improved as well in the period after centralisation of surgery. Nevertheless, many gastric cancer patients that are eligible for perioperative treatment do not receive the adjuvant component of perioperative treatment or they do not receive chemotherapy at all in addition to surgery. Furthermore, survival remained stable for patients with metastatic gastric cancer, despite an increase in the use of palliative chemotherapy. To conclude, the studies in this thesis addressed several important challenges in diagnosis and treatment of oesophageal and gastric cancer

Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer

Purpose. This study was designed to assess the impact of age and comorbidity on choice and outcome of definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy plus surgery. Methods. In this population-based study, all patients with potentially curable EC (cT1N?/cT2-3, TX, any cN, cM0) diagnosed in the South East of the Netherlands between 2004 and 2014 were included. Kaplan–Meier method with log-rank tests and multivariable Cox regression analysis were used to compare overall survival (OS). Results. A total of 702 patients was included. Age C 75 years and multiple comorbidities were associated with a higher

Poor compliance with perioperative chemotherapy for resectable gastric cancer and its impact on survival

Background: In several Western European countries it is recommended to treat gastric cancer patients with perioperative chemotherapy if they are eligible for surgery. However, little is known about its use in daily clinical practice. This study examines the use of perioperative treatment and its impact on survival in the Netherlands. Methods: Patients diagnosed with potentially resectable gastric cancer (cT1N+/cT2-T3,X any cN, cM0,X) between 2006 and 2014 were selected from the Netherlands Cancer Registry (N = 5824). Treatment trends were examined. Propensity score matching was used to create a subsample to reduce selection bias. Cox regression analysis was used to assess differences in overall survival. Results: The percentage of patients treated with perioperative treatment increased from 3% in 2006 to 26% in 2014 and the use of only surgery decreased from 60% to 26%. 35% of all patients did not undergo surgery. Of the patients who underwent preoperative chemotherapy and surgery, 43% did not commence postoperative treatment. Cox regression analysis showed a better overall survival for patients who underwent perioperative treatment compared to patients who underwent preoperative treatment only (HR = 0.80 95%CI 0.70–0.93; propensity matched sample: HR = 0.84 95%CI 0.71–0.99), whereas survival was comparable for patients who underwent preoperative chemotherapy versus surgery alone (HR = 0.89 95%CI 0.77–1.02, propensity matched sample: HR = 0.85 95%CI 0.72–1.01). Conclusion: This population-based study highlights that a significant proportion of the patients did not receive perioperative treatment. More research is necessary to elucidate the importance of the individual components of perioperative treatment