title: Description and analysis of clinical pathways for oesophago-gastric adenocarcinoma, in 10 European countries (the EURECCA upper gastro intestinal group - European Registration of Cancer Care).
abstract: OBJECTIVE
  Outcomes for patients with oesophago-gastric cancer are variable across Europe. The reasons for this variability are not clear. The aim of this study was to describe and analyse clinical pathways to understand differences in service provision for oesophageal and gastric cancer in the countries participating in the EURECCA Upper GI group.
  
  
  METHODS
  A questionnaire was devised to assess clinical presentation, diagnosis, staging, treatment, pathology, follow-up and service frameworks across Europe for patients with oesophageal and gastric cancer. The questionnaire was issued to experts from 14 countries. The responses were analysed quantitatively and qualitatively and compared.
  
  
  RESULTS
  The response rate was (10/14) 71.4%. The approach to diagnosis was similar. Most countries established a diagnosis within 3 weeks of presentation. However, there were different approaches to staging with variable use of endoscopic ultrasound reflecting availability. There has been centralisation of treatments in most countries for oesophageal surgery. The most consistent area was the approach to pathology. There were variations in access to specialist nurse and dietitian support. Although most countries have multidisciplinary teams, their composition and frequency of meetings varied. The two main areas of significant difference were research and audit and overall service provision. Observations on service framework indicated that limited resources restricted many of the services.
  
  
  CONCLUSIONS
  The principle approaches to diagnosis, treatment and pathology were similar. Factors affecting the quality of patient experience were variable. This may reflect availability of resources. Standard pathways of care may enhance both the quality of treatment and patient experience.
authors.affiliation: Department of Surgery, Royal Marsden NHS Foundation Trust, London, UK; Department of Digestive Surgery, Lille University Hospital, France.
authors.forename: M
authors.initials: M
authors.lastname: Messager
authors.affiliation: EURECCA, Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: de Steur
authors.affiliation: EURECCA, Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: P G
authors.initials: PG
authors.lastname: Boelens
authors.affiliation: Department of Surgery Danish Oesophageal, GEJ and Gastric Cancer Group Att. University Aarhus, NBG, Denmark.
authors.forename: L S
authors.initials: LS
authors.lastname: Jensen
authors.affiliation: Department of Digestive Surgery, Lille University Hospital, France.
authors.forename: C
authors.initials: C
authors.lastname: Mariette
authors.affiliation: Department of Surgery, St. James's Hospital, Dublin, Ireland.
authors.forename: J V
authors.initials: JV
authors.lastname: Reynolds
authors.affiliation: Department of Surgery, Hospital Mutua de Terrasa, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Osorio
authors.affiliation: Department of Surgery, Hospital Mutua de Terrasa, Barcelona, Spain; Hospital Universitario del Mar., Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pera
authors.affiliation: Department of Surgery, Lund University Hospital, Lund, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Johansson
authors.affiliation: Department of Surgery, Jagiellonian University, Krakow, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Kołodziejczyk
authors.affiliation: Italian Research Group for Gastric Cancer (GIRCG - ONLUS), Italy.
authors.forename: F
authors.initials: F
authors.lastname: Roviello
authors.affiliation: Italian Research Group for Gastric Cancer (GIRCG - ONLUS), Italy.
authors.forename: G
authors.initials: G
authors.lastname: De Manzoni
authors.affiliation: Department of General, Visceral & Cancer Surgery, University Hospital of Cologne, Germany.
authors.forename: S P
authors.initials: SP
authors.lastname: Mönig
authors.affiliation: Department of Surgery, Royal Marsden NHS Foundation Trust, London, UK. Electronic address: William.Allum@rmh.nhs.uk.
authors.forename: W H
authors.initials: WH
authors.lastname: Allum
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D000818:Animals; D019091:Critical Pathways; D003718:Denmark; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D005060:Europe; D005602:France; D000072102:Gastroenterologists; D005858:Germany; D006291:Health Policy; D006801:Humans; D007494:Ireland; D007558:Italy; D009367:Neoplasm Staging; D009426:Netherlands; D000072103:Oncologists; D010348:Patient Care Team; D011044:Poland; D011787:Quality of Health Care; D012042:Registries; D013030:Spain; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D066231:Surgeons; D011795:Surveys and Questionnaires; D013548:Sweden; D013997:Time Factors; D006113:United Kingdom
keywords: Care pathway; Clinical pathway; EURECCA; Gastric cancer; National health policy; Oesophageal cancer