title: Trends and variation in the management of oesophagogastric cancer patients: a population-based survey.
abstract: BACKGROUND
  Previous evidence indicates potential variation in the quality of care of cancer patients. We aimed to examine whether recent changes in the treatment of oesophagogastric cancers have been distributed equally among different patient subgroups.
  
  
  METHODS
  We analysed population-based cancer registry data about the treatment patterning of oesophagogastric cancer (other than oesophageal squamous cell carcinoma) during 1995-2006.
  
  
  RESULTS
  There were 14,077 patients aged > or =40 years (69% men). There was only limited information on stage, and no information on co-morbidity status. During successive triennia, curative surgery use decreased from 28% to 20% (p < 0.001) whilst chemotherapy use increased from 9% to 30% (p < 0.001). Use of palliative surgery and of radiotherapy increased significantly but modestly (7% to 10%, and 9% to 11%, respectively). In multivariable logistic regression adjusting for age group, gender, diagnosis period and tumour type, curative surgery and chemotherapy were used less frequently in more deprived patients [per increasing deprivation group Odds Ratio (OR) = 0.96, 95% Confidence Interval (CI) 0.93-0.99, and OR = 0.90, 95%CI 0.87-0.93, respectively, p < 0.001 for both)]. Chemotherapy was also used less frequently in women (OR = 0.76, p < 0.001).
  
  
  CONCLUSIONS
  During the study period, curative surgery decreased by a third and chemotherapy use increased by more than three-fold, reflecting improvements in the appropriateness and quality of management, but chemotherapy use, in particular, was unequal, both by socioeconomic status and gender.
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK. gl290@medschl.cam.ac.uk
authors.forename: Georgios
authors.initials: G
authors.lastname: Lyratzopoulos
authors.forename: Josephine M
authors.initials: JM
authors.lastname: Barbiere
authors.forename: Chetna
authors.initials: C
authors.lastname: Gajperia
authors.forename: Michael
authors.initials: M
authors.lastname: Rhodes
authors.forename: David C
authors.initials: DC
authors.lastname: Greenberg
authors.forename: Karen A
authors.initials: KA
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use; D004194:Disease; D019468:Disease Management; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000970:Antineoplastic Agents