title: Recent trends and predictors of multimodality treatment for oesophageal, oesophagogastric junction, and gastric cancer: A Dutch cohort-study.
abstract: BACKGROUND
  In recent years, evidence supporting multimodality treatment for oesophageal, oesophagogastric junction (OGJ), and gastric cancer has accumulated. This population-based cohort-study investigates trends and predictors of utilisation of multimodality treatment for oesophagogastric cancer in the Netherlands.
  
  
  METHODS
  Data were obtained from the Netherlands Cancer Registry regarding patients with oesophageal (n = 5450), OGJ (n = 2168) and gastric cancer (n = 6683) without distant metastases who had undergone R0 or R1 surgery diagnosed between 2000 and 2012. Follow-up was completed until February 2014. Preoperative/postoperative chemotherapy and/or radiotherapy combined with surgery were considered multimodality treatment. Logistic regression analysis was performed to analyse the association of age, gender, socioeconomic status, clinical T and N classification, hospital type, comprehensive cancer centre network region, and year of diagnosis, with multimodality treatment receipt. Additional analyses were performed to explore differences in trends of utilisation of multimodality treatment between academic and non-academic hospitals.
  
  
  RESULTS
  Multimodality treatment utilisation for oesophageal, OGJ and gastric cancer increased significantly to 90%, 85% and 56% in 2012, respectively. In oesophageal and OGJ cancer patients, preoperative chemoradiotherapy was most frequently administered (85% and 47% in 2012, respectively), and in gastric cancer patients preoperative chemotherapy (47% in 2012). Lower age, higher clinical T and N classification, and diagnosis in more recent years were significantly associated with more frequent multimodality treatment receipt. The adoption of most types of multimodality treatment in academic hospitals preceded non-academic hospitals by a year.
  
  
  CONCLUSIONS
  In the Netherlands, the utilisation of multimodality treatment for oesophagogastric cancer has significantly increased during the past decade, especially in oesophageal and OGJ cancer. Multimodality treatment utilisation was especially dependent on patient and tumour characteristics and year of diagnosis, but multimodality treatment trends seem to be related to the publication of landmark studies, participation in nationally running clinical trials, and hospital type, preceding national guidelines.
authors: a Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.
authors: Anouk K
authors: AK
authors: Trip
authors: b Department of Surgery The Netherlands Cancer Institute , Amsterdam , The Netherlands.
authors: Jurriën
authors: J
authors: Stiekema
authors: c Department of Registration & Research , Comprehensive Cancer Centre The Netherlands , Utrecht , The Netherlands.
authors: Otto
authors: O
authors: Visser
authors: a Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.|d Department of Surgery , Leiden University Medical Centre , Leiden , The Netherlands.
authors: Johan L
authors: JL
authors: Dikken
authors: e Department of Gastroenterology and Hepatology The Netherlands Cancer Institute , Amsterdam , The Netherlands.
authors: Annemieke
authors: A
authors: Cats
authors: e Department of Gastroenterology and Hepatology The Netherlands Cancer Institute , Amsterdam , The Netherlands.
authors: Henk
authors: H
authors: Boot
authors: b Department of Surgery The Netherlands Cancer Institute , Amsterdam , The Netherlands.
authors: Johanna W
authors: JW
authors: van Sandick
authors: a Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.
authors: Edwin P M
authors: EP
authors: Jansen
authors: a Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.
authors: Marcel
authors: M
authors: Verheij
mesh_terms: D000046:Academic Medical Centers / Q000639:trends; D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000367:Age Factors; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000706:statistics & numerical data / Q000639:trends; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data / Q000639:trends; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000706:statistics & numerical data / Q000639:trends*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*