02 July 2012
A greater proportion of patients who have curative treatment for oesophageal or stomach cancer are living longer after diagnosis, according to new findings released today by 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 – found that nearly 50% of patients with stomach tumours and around 45% of patients with an oesophageal tumour were still alive three years after diagnosis. Ten years ago, only about one third of patients survived longer than three years.
The audit is the largest of its kind in the world and collected data on more than 17,000 patients in England and Wales diagnosed between October 2007 and June 2009. It is the first time that national data on three year survival rates for this patient group has been published.
It shows that if patients are diagnosed early enough and have curative treatment their chances of long-term survival are stronger.
The 2012 Annual Report of the National Oesophago-Gastric Cancer Audit also highlights that the pattern of referral from general practice to hospital varies significantly by region in England and Wales. The proportion of patients who were diagnosed after an urgent GP referral ranged from 88 per cent to 38 per cent among the regional cancer networks.
In addition, 16 per cent of patients were diagnosed with cancer after an emergency hospital admission. These patients are less likely to benefit from treatment than patients diagnosed after a GP referral as the disease has advanced considerably.
Stuart Riley, Consultant Gastroenterologist and member of the British Society of Gastroenterology (BSG), said:
“Unfortunately, most patients with oesophageal or stomach cancer still report symptoms too late. We need to improve the early diagnosis of the disease to increase the proportion of patients eligible for curative treatment and improve survival rates even further.”
Together, oesophageal and stomach cancersare the fourth most common cause of cancer death in the United Kingdom, affecting around 13,500 people each year.
The improved results outlined in the audit reflect better organisation of NHS cancer services in England and Wales.
The centralisation of cancer services has allowed patients to have better access to the best available treatment.More than two-thirds (71%) of local hospitals have now combined multi-disciplinary team meetings with specialised hospitals, compared to one third (34%) five years ago. This has transformed patient care and surgery is now safer than it was 10 years ago.
Richard Hardwick, Consultant Surgeon and member of the Association of Upper GI Surgeons (AUGIS), said “Survival of patients undergoing curative surgery for oesophageal or stomach cancerhas improved significantly. Our next challenge is to reduce the rates of complications following these major operations so that our patients recover more quickly from their surgery”
Tom Crosby, Consultant Clinical Oncologist and member of the Royal College of Radiology (RCR), said “Chemo-radiotherapy is now a well-established option in the treatment of oesophageal and stomach cancer. Combining it with surgery has helped improve the time patients survive, indeed in some cases surgery is not necessary. We must ensure all patients to have access to equally excellent services.”
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Notes for editors:
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 reorganisation of Cancer Services was recommended first in the Calman Hine Report (1995). The previous organisational audit demonstrated that the reorganisation was still incomplete in 2007 (Palser T, Cromwell D, Hardwick R et al Re-organisation of oesophago-gastric cancer care in England: progress and remaining challenges.BMC Health Services Research 2009, 9: 204
3 Survival after curative surgery has improved over the years. In the late 1990’s, three year survival for oesophago-gastric cancer patients undergoing curative resection was about 34% for oesophageal tumours and 40% for stomach tumours (Rouvelas I. et al. Survival after neoadjuvant therapy compared with surgery alone for resectableesophageal cancer in a population-based study. World Journal of Surgery 2006, 30: 2182-2190,Cunningham D et al. Perioperative chemotherapy versus surgery alone for resectablegastroesophageal Cancer. New England Journal of Medicine 2006, 355:11-20). To facilitate comparability, weighted averages of survival rates were calculated based on published data.
4 The principal aim of palliative care is to improve patient quality of life by alleviating pain and controlling other symptoms as well as providing psychological and social support. Palliative treatments essentially fall into three groups: conservative (best supportive care), oncological (chemotherapy, radiotherapy or a combination of the two) or endoscopic / radiological (stenting, thermal ablation and brachytherapy). Patients with stomach cancersthat are obstructing the passage of food may also have palliative surgery to remove the obstruction.
5 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. For more information please visit www.rcseng.ac.uk