Patterns of care and clinical outcomes for gastric and gastro-oesophageal cancers in South Australian population: Initial results of a state-wide audit
Authors: N. Abbas, M. Barnes, T. Price, C. Karapetis, T. Bright, J. Bull, R. Gowda, N. Rodgers, D. Watson, C. Connell, S. Thompson, J. Shenfine, N. Singhal, A. Roy
Journal: Annals of Oncology (2018)

Introduction: The South Australian state-wide Upper gastrointestinal (GI) cancer video linked multidisciplinary team (MDT) meeting encompassing four tertiary hospitals was established in 2009. The primary aim of the MDT is to discuss overall management and provide evidence based care to all newly diagnosed oesophageal, gastro-oesophageal junction (GOJ) and gastric cancer patients. We conducted a retrospective audit to review the patterns of care and patient outcomes for gastro-oesophageal junction (GOJ) and gastric cancers on the state-wide database. Methods: Data is collected for patients with gastric and GOJ cancers (excluding lymphomas, neuroendocrine tumours, small cell and gastrointestinal stromal tumours) presented at the MDT from June 2012 to June 2016. Sources included upper GI MDT, public hospital electronic health records and pathology and pharmacy records from private health providers. Data on patient demographics, TNM stage, histological types, modalities used for diagnosis and treatment received was collected. Based on the treatment provided stage specific survival outcomes were analysed using descriptive statistics. Results: 250 patients have been presented and of these, results of 61 are available for this analysis. Majority of patients were Caucasian (male 40, female 21) with mean age of 69 years (range 62 - 78 years). Fifty-one patients (84%) and 10 patients (16%) had gastric and gastro-oesophageal junction cancer respectively. Thirty (49%), 20 (33%) and 11(18%) patients had stage IV, III and I/II cancer respectively. Histological types included 53 (87%) adenocarcinomas, 7 (11%) signet ring carcinoma and 1 epithelial carcinoma. Diagnostic workup for early stage cancers (stage I-III) included twenty-three (74%) patients who underwent staging laparoscopy, 7 patients (23%) had PET scan and 4 patients (13%) had endoscopic ultrasound. Staging laparotomy, PET scan and endoscopic ultrasound was performed for 17 (57%), 5(16%) and 4 (13%) patients with stage IV disease. Surgery was performed in 25 patients (100%) for early stage disease (16 had total gastrectomy, 9 had subtotal gastrectomy) and 21 (84%) patients had complete resection (R0). Twenty-eight (46%) patients received palliative chemotherapy and radiotherapy and 6 (10%) patients were given symptom directed therapy alone. Median overall survival for stage IV, stage III and stage II disease was 6.6, 22.8 and 58.8 months respectively. Patients with stage IV cancer who received symptom directed therapy alone, palliative radiotherapy and palliative chemotherapy had median overall survival 1.4 months (95% CI, 0.8 to 3.0), 4.32 (95% CI, 3.4 to 6.9) months and 9.8 months (95% Confidence Interval, 8.6 to 13.4) respectively. Median overall survival for early stage cancer (stage I-III) patients who received perioperative chemotherapy and surgery was not reached (95% CI, 24.8 to Not Reached) and surgery alone had median overall survival 57.6 months (95% CI, 54 – Not Reached). Conclusion: Patient outcomes analysed in the sample population reflect real world practice. Analysis of additional patients is ongoing and will be included in late breaking abstract.