Patterns of care and effects on mortality for cancers of the oesophagus and gastric cardia: a population-based study.
BACKGROUND
We investigated temporal trends in treatment, and factors influencing treatment receipt and survival, for upper gastrointestinal cancers in routine community-based clinical practice.


METHODS
Oesophageal and gastric-cardia cancers, diagnosed during the period 1994-2001, were sourced from the National Cancer Registry (Ireland). Analysis was by Joinpoint regression and multivariate logistic and Cox models.


RESULTS
Thirty-five percent of patients received surgery, 35% radiotherapy and 24% chemotherapy. Over time chemo- and radiotherapy receipt increased significantly, whilst surgery decreased. Treatment patterns varied by tumour site, histology and stage. Older and/or unmarried patients were significantly less likely to receive treatment. Among surgically treated patients, those aged 70+ had higher mortality. Among both surgical and non-surgical patients, those receiving chemotherapy or radiotherapy had a modest, short-term, survival benefit.


CONCLUSIONS
The use of adjuvant therapies is increasing in routine practice. After adjusting for clinical factors, patient-related factors predicted treatment and mortality. Improving equity in gastrointestinal cancer treatment may help improve survival.
Cronin-Fenton
D P
DP
National Cancer Registry, Ireland, Elm Court, Boreenmanna Road, Cork, Ireland. dc@dce.au.dk
Sharp
L
L
Carsin
A-E
AE
Comber
H
H
D000328:Adult; D000368:Aged; D002299:Cardia; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008875:Middle Aged; D012044:Regression Analysis; D013274:Stomach Neoplasms / Q000401:mortality / Q000628:therapy*