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Early diagnosis and specialist care vital for stomach and oesophageal cancer patients

26 June 2013

More stomach and oesophageal cancer patient lives could be saved if cancers are detected early. All too often, patients are being diagnosed after an emergency admission to hospital which significantly reduces the likelihood of the tumour being operable, finds the National Oesophago-Gastric Cancer Audit.

The Audit – commissioned by the Healthcare Quality Improvement Partnership, and carried out by a partnership between the Association of Upper Gastro-Intestinal Surgeons, the British Society of Gastroenterology, the Royal College of Radiologists, the Health and Social Care Information Centre and the Royal College of Surgeons of England - examined 11,516 cases and found that 15% of patients with a stomach or oesophageal tumour were diagnosed after an emergency admission. These patients are less likely to benefit from life-saving treatment than patients diagnosed after a GP referral as the disease is more likely to be advanced.

The study reveals substantial regional variation between cancer networks in the proportion of patients diagnosed after emergency admission. As many as one in three patients in the northwest London region were diagnosed following an emergency admission compared to one in every twenty in the Greater Midlands.

Stomach and oesophageal cancers are particularly aggressive and prognosis is extremely poor if caught at a late stage. Each year around 13,500 patients are diagnosed with stomach and oesophageal cancer in England, making it the fourth most common cause of cancer death in the UK. The disease is often only detected at a late stage because many of the symptoms and signs are non-specific and common in large numbers of individuals without cancer.

Stuart Riley, Consultant Gastroenterologist and member of the British Society of Gastroenterology (BSG), said:
“Stomach and oesophageal cancer typically afflicts the elderly, and men are twice as likely to be affected compared to women. This study makes it clear just how important it is for patients to receive an early diagnosis as these are particularly aggressive forms of cancer. The public should be made aware of the alarm symptoms which include problems with swallowing, persistent vomiting and weight loss. National guidelines recommend that GPs make an urgent referral for an endoscopy assessment if a patient comes to them with these symptoms.”

The audit, which began in 2006 and is now the largest of its kind in the world, found that of the patients suitable for life-saving treatment nearly 50% of those with a stomach tumour and around 45% of those with a oesophageal tumour were still alive three years after diagnosis. Ten years ago, only about one third of patients survived longer than three years. Additionally, the number of people dying 30-days after surgery (the critical period where complications can occur following a major operation) has fallen year after year to 1.7% for oesophageal cancer patients and 1.1% for stomach cancer patients.

The improved results outlined in the audit reflect the better organisation of NHS cancer services in England and Wales. The centralisation of cancer services has enabled patients to have improved access to the best available treatment. Today, all hospitals which treat these cancers now have combined multi-disciplinary team meetings where surgeons and oncologists assess each patient and agree a treatment plan. This has transformed patient care and surgery is now safer than it was a decade ago.

Richard Hardwick, Consultant Surgeon and member of the Association of Upper GI Surgeons (AUGIS), said:
“The creation of specialist cancer centres has reduced post-operative mortality dramatically and surgery is safer now than it has ever been. However, many of our patients are elderly with other health problems, so complication rates after treatment remain stubbornly high and recovery from these major operations takes many months. We must continue to explore ways to better prepare our patients for surgery and expedite their recovery”.

The audit highlighted that over a third of patients with a stomach or oesophageal tumour had at least one other long-term disease such as diabetes and over 10 per cent were so frail they were confined to bed for more than 50% of the time. This further demonstrates the complex needs of this patient group.

The National Oesophago-Gastric Cancer Audit 2013 is available online.

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Notes to the editor:

1. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.

2. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808.