Variation in Diagnosis, Treatment, and Outcome of Esophageal Cancer in a Regionalized Care System in Ontario, Canada
| Autor: | Claire M. B. Holloway, Gail Darling, Katharina Forster, Olga Yermakhanova, Steven Habbous |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Hospitals Low-Volume Esophageal Neoplasms Waiting Lists medicine.medical_treatment Endoscopic mucosal resection Adenocarcinoma Regional Medical Programs Cohort Studies Internal medicine medicine Adjuvant therapy Humans Postoperative Period Radiation oncologist Neoadjuvant therapy Original Investigation Aged Aged 80 and over Ontario business.industry Research Cancer Thoracic Surgery General Medicine Esophageal cancer Middle Aged medicine.disease Cancer registry Survival Rate Online Only Treatment Outcome Oncology Esophagectomy Female business Hospitals High-Volume |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | Key Points Question Was there a uniform approach to diagnosis, staging, and treatment of patients with esophageal cancer after regionalization of thoracic surgery in Ontario, Canada? Findings In this cohort study of 10 364 patients, there was significant variation in use of staging tests as well as approach to treatment. Postoperative 30- and 90-day mortality was found to be reduced at high-volume centers. Meaning Despite regionalization of thoracic surgery, there remains significant variation between centers in the use of staging tests, treatments, and short-term mortality. This cohort study assesses variations in the diagnosis, staging, and treatment of patients with esophageal cancer after regionalization of thoracic surgery in Ontario, Canada. Importance Esophageal cancer remains one of the most deadly cancers, ranking sixth highest among cancers leading to the greatest years of life lost. Objective To determine how patients with esophageal cancer are diagnosed and treated in Ontario’s regionalized thoracic surgery centers. Design, Setting, and Participants This cohort study included patients diagnosed with esophageal cancer between January 1, 2010, and December 31, 2018, identified from the Ontario Cancer Registry, in a single-payer health care system with regionalization of thoracic surgery in the province of Ontario, Canada. Exposures Exposures included incidence of esophageal cancer and stage at diagnosis; time from the first health care visit until treatment; and the use of specialist consultations, endoscopic ultrasonography, positron emission tomography and computed tomography, endomucosal resection, esophagectomy, neoadjuvant therapy, adjuvant therapy, radiation alone, and chemotherapy alone or in combination with other treatment. Main Outcomes and Measures Outcome measures included wait times, health care use, treatment, and overall survival. Data were analyzed from March 2020 to February 2021. Results There were 10 364 patients (mean [SD] age, 68.3 [11.9] years; 7876 men [76%]) identified during the study period. The incidence of esophageal cancer increased over the study period from 1041 in 2010 to 1309 in 2018, which was driven by a 30% increase in the number of adenocarcinomas. The time from first health care encounter to start of treatment was a median 93 days (interquartile range, 56-159 days). Endoscopic ultrasonography was observed for 12% of patients, and positron emission tomography and computed tomography (CT) in 45%. Use of endoscopic mucosal resection was observed for 8% of patients with stage 0 to I disease. A total of 114 of 547 patients (21%) receiving endoscopic resection had a subsequent esophagectomy. Only 2778 patients (27%) had consultations with a thoracic surgeon, a medical oncologist, and a radiation oncologist, whereas 1514 patients (15%) did not see any of these specialists. Of 3047 patients who had an esophagectomy, those receiving neoadjuvant therapy had better overall survival (median survival, 36 months; 95% CI, 32-39 months) than patients who received esophagectomy alone (median survival, 27 months; 95% CI, 24-30 months) or those who received esophagectomy with adjuvant therapy (median survival, 36 months; 95% CI, 32-44 months) despite significant early mortality (log-rank P |
| Databáze: | OpenAIRE |
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