Variations among 5 European countries for curative treatment of resectable oesophageal and gastric cancer: A survey from the EURECCA Upper GI Group (EUropean REgistration of Cancer CAre)
Introduction
Overall survival for patients with gastric and oesophageal cancer has shown little improvement over the last 20 years. For gastric cancer the recent EUROCARE-5 study has shown a slight improvement in 5-year survival from 23.3% in 1999–2001 to 25.1% in 2005–2007.1 This study also highlighted significant geographical differences across Europe with highest survival in southern and central Europe and lowest survival in Eastern Europe, the UK and Ireland. The overall 5-year survival for oesophageal cancer also remains poor at 12%. The main reason for the poor outcome is the late stage at diagnosis for both cancer sites. However, geographical differences may reflect differences in patterns of treatment.
Most population-based studies provide a broad overview, but may lack more detailed information on staging and treatment necessary to intervene and improve patterns of care. Prospective cancer audits maintained in real-time provide very valuable tools for improvement as it happens. Dikken et al. combined information from four countries using either national registry data or national audit outcomes.2 Although the databases were not complete, reflecting intra-country variations in data recording, there were considerable variations in treatment practices and outcomes particularly for surgical resection rates and postoperative mortality. This study highlighted the need to develop a much larger collaborative approach to be able to compare and contrast current approaches to oesophageal and gastric cancer and search for the best care for this specific patient group.
In colorectal cancer, the EURECCA initiative has demonstrated how to establish an audit across European countries.3 Following this model the EURECCA Upper GI project was established and a common dataset was developed using existing data items recorded in 7 countries.4 This study reports the results of comparison of these data items in the initial 5 countries collaborating in the project.
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Materials and methods
Five countries (Netherlands, France, Spain, UK and Ireland) have collected data on patients with oesophageal and gastric cancer treated with curative intent over a 1-year period (2011–2012). Inclusion criteria were patients with SCC and ACA of the oesophagus, oesophago-gastric junction and stomach who underwent curative treatment including surgery. Each country submitted data using a dataset of 46 items identified as common to all data sources.4 Briefly, this dataset involved collection of
Epidemiology
During the 12 months period, 4668 cases have been recorded across the 5 countries, 2666 oesophageal and GOJ (gastro-oesophageal junction) tumours and 2002 gastric cancers (Table 1). The majority of these were planned for resection although a small number from the Netherlands and Ireland planned for non-surgical treatments have been included. The proportion of oesophageal and junctional cancers predominated in all countries except Spain where there were more gastric cancers.
The majority were
Discussion
The aim of the EURECCA project is to improve the quality and reduce the variation of cancer care by data registration, feedback, forming plans for improvement and sharing knowledge of performance and science. This study is the first, descriptive comparison of current practice in the management of oesophageal and gastric cancer in a number of European countries. It reflects activity in a recent period (2011–12) and demonstrates how a collaborative international project can be established
Conflict of interest
The authors declare no conflict of interest.
Funding
The 2013 Annual Grant for international mobility from the AFC (French Association of Surgery) was part of the salary of MM.
Acknowledgements
The authors would like to thank all the participating countries and participants of the EURECCA Upper GI Group for their input and providing the results from the 10th International Gastric Cancer Congress (IGCC) presentations, in Verona, Italy, and the organizing committee of the 10th IGCC congress. The authors would also like to thank. Georgina Chadwick and Oliver Groene from the UK National OG Cancer Audit for their help.
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