title: Variation in palliative care of esophageal cancer in clinical practice: factors associated with treatment decisions.
abstract: Various treatments are available for the palliation of esophageal cancer, but the optimal therapeutic approach is unclear. This study aimed to assess the palliative treatment modalities used in patients with inoperable esophageal cancer and to identify factors associated with treatment decisions. A population-based, retrospective cohort study was conducted using data from the nationwide Netherlands Cancer Registry and medical records of seven participating hospitals. Patients diagnosed with stage III-IV inoperable esophageal or gastric cardia cancer in the central part of the Netherlands between 2001 and 2010 were included. Logistic regression analyses were performed to identify determinants of treatment choices. In total, 736 patients were initially treated with best supportive care (21%), stent placement (19%), chemotherapy (18%), external beam radiotherapy (EBRT) (16%), brachytherapy (6%), a combination of EBRT and brachytherapy (6%), a combination of chemotherapy and EBRT (5%) or another treatment (9%). The palliative approach varied for disease stage (P < 0.01) and hospital of diagnosis (P < 0.01). Independent factors affecting treatment decisions were age, degree of dysphagia, tumor histology, tumor localization, disease stage, and hospital of diagnosis. For example, patients diagnosed in one hospital were less likely to be treated with EBRT than with stent placement compared to patients in another hospital (odds ratio 0.20, 95% confidence interval 0.07-0.59). In conclusion, the initial palliative approach of patients with inoperable esophageal cancer varies widely and is not only associated with patient- and disease-related factors, but also with hospital of diagnosis. These findings suggest a lack of therapeutic guidance and highlight the need for more evidence on palliative care strategies for esophageal cancer.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.|The Stichts Genootschap, a collaborative group of gastroenterologists and gastrointestinal surgeons in the region of Utrecht, The Netherlands.
authors.forename: Jorrit L
authors.initials: JL
authors.lastname: Opstelten
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Laetitia R H
authors.initials: LR
authors.lastname: de Wijkerslooth
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Max
authors.initials: M
authors.lastname: Leenders
authors.affiliation: Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, The Netherlands.
authors.forename: Dirk Jan
authors.initials: DJ
authors.lastname: Bac
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Menno A
authors.initials: MA
authors.lastname: Brink
authors.affiliation: Department of Internal Medicine, Zuwe Hofpoort hospital, Woerden. The Netherlands.
authors.forename: Boudewijn C A J
authors.initials: BC
authors.lastname: Loffeld
authors.affiliation: Department of Gastroenterology and Hepatology, Hospital St. Jansdal, Harderwijk, The Netherlands.
authors.forename: Mariëlle J F
authors.initials: MJ
authors.lastname: Meijnen-Bult
authors.affiliation: Department of Gastroenterology and Hepatology, Tergooi hospitals, Blaricum/Hilversum, The Netherlands.
authors.forename: Itta M
authors.initials: IM
authors.lastname: Minderhoud
authors.affiliation: Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht/Zeist, The Netherlands.
authors.forename: Marc A M T
authors.initials: MA
authors.lastname: Verhagen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods; D002299:Cardia / Q000473:pathology*; D059248:Chemoradiotherapy / Q000379:methods; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D010166:Palliative Care / Q000379:methods*; D018579:Patient Selection; D011878:Radiotherapy / Q000379:methods; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: cohort study; decision-making; esophageal cancer; palliative care