More than half of stomach cancer patients receiving surgical alternatives, report finds
Published: 07 Sep 2016
The proportion of patients with oesophageal and gastric cancer (O-G cancer) – or gullet and stomach cancer – who were eligible for life-saving treatment, has increased slightly over the past eight years, according to the largest study of these types of cancers in England and Wales. Over a third of patients – 37.6 per cent – received life-saving or curative treatment between 2013-2015, compared to 35.9 per cent between 2007 and 2009, when this patient group was first studied.
The National Oesophago-Gastric Cancer Audit (NOGCA) also found that for patients with some oesophageal cancers, chemo-radiation has become an alternative to surgery, offering patients who are unfit for surgery a chance of being cured. The proportion of patients with these cancers having chemo-radiation has increased from 38 per cent in 2007-09 to 52 per cent in 2013-15.
O-G cancer is the fifth most common cancer in the UK and it affects approximately 16,000 people every year. However, as patients often only experience symptoms when the disease is fairly advanced, the prognosis for patients remains poor. Five year survival rates for O-G cancer are 15 % and 19 % respectively . Experts warn that a better way to diagnose the disease is ‘desperately needed’ to improve survival rates.
Dr Stuart Riley, a Consultant Gastroenterologist who is part of the audit team, said:
“Survival rates for O-G cancer have been slow to improve because is it very difficult to diagnose. At the moment too many people are being diagnosed as emergency admissions and we know at that stage they are likely to have worse outcomes. To really have a chance of tackling this awful disease we desperately need a better way of diagnosing it.”
The Audit was set up in 2006 to investigate whether patients with this type of cancer receive care that is consistent with recommended guidelines; and to identify areas where improvements could be made. It examined the care of 21,133 patients diagnosed in hospitals in England and Wales between April 2013 and March 2015. This represents approximately 78 per cent of all patients diagnosed with the disease in England.
Dr Tom Crosby, a Consultant Clinical Oncologist, who also was involved in the audit said:
“O-G cancer is often diagnosed at an advanced stage as many of the symptoms are non-specific and present in individuals who do not have the disease. While our audit shows welcome progress is being made in improving survival rates, this is happening too slowly. Referral for, and access to effective treatment is often delayed, and we need to improve this.
“Recent studies led by researchers in the UK have shown that a combination of chemotherapy and radiotherapy can be as effective as surgery for certain patient groups. All patients should be considered for this treatment if the disease has not spread.”
The 2016 Annual Report for the National Oesophago-Gastric Cancer Audit found:
• The proportion of patients with O-G cancer who were eligible for curative, or life-saving treatment, has increased slightly since the first audit. Over a third of patients – 37.6 per cent – received life-saving or curative treatment between 2013-2015, compared to 35.9 per cent between 2007 and 2009, when this patient group was first studied.
• The proportion of patients diagnosed with O-G cancer as a result of an emergency admission has decreased, from 15.3% in the first audit to 13.7% between 2013 and 2015. Patients diagnosed as a result of an emergency are less likely to be able to have curative treatment, so this is a positive development.
• However, a sixth of patients are still diagnosed after an emergency admission. Improving awareness of the disease among patients and improving the diagnostic process is important to increasing survival rates. [Clinical guidelines recommend that GPs make an urgent referral for patients aged over 55 who are suspected of having O-G cancer.]
The authors of the report say it is important that NHS trusts monitor these rates, take steps at a local level to identify possible reasons for this where levels are high and make changes aimed at reducing this in future.
Variation between NHS providers in the diagnosis of O-G cancer after an emergency admission was also identified by the audit and the report recommends NHS providers work together to develop strategies for reducing this figure.
The Audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by a partnership between the Association of Upper Gastro-Intestinal Surgeons, the British Society of Gastroenterology, the Royal College of Radiologists, the Health and Social Care Information Centre, and the Royal College of Surgeons of England .
The full version of the Annual Report for the National Oesophago-Gastric Cancer Audit (NOGCA) 2016 is available from the HQIP website and at: http://www.hscic.gov.uk/og