Article Text


Oesophageal II
PWE-022 Completion rates of palliative chemotherapy are low in patients with oesophago-gastric cancer: results from a national audit
  1. O Groene1,
  2. R Hardwick2,
  3. S Riley3,
  4. T Crosby4,
  5. K Greenaway5,
  6. D Cromwell6
  1. 1Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  2. 2Addenbrooke's, Cambridge, UK
  3. 3Northern General Hospital, Sheffield, UK
  4. 4Velindre Cancer Center, Cardiff, UK
  5. 5NHS Information Centre, Leeds, UK
  6. 6London School of Hygiene & Tropical Medicine, London, UK


Introduction Palliative chemotherapy is routinely offered to patients diagnosed with locally advanced or metastatic oesophago-gastric cancer. Based on data from the National Oesophago-Gastric Cancer Audit (NOGCA), we describe the characteristics of patients being offered palliative chemotherapy, determine the proportion of patients completing treatment, and identify factors associated with treatment completion.

Methods The NOGCA prospectively collected data on patients diagnosed with invasive epithelial cancer of the oesophagus or stomach between 1 October 2007 and 30 June 2009. For patients receiving palliative oncology, we compared characteristics of completers and non-completers of chemotherapy using χ2 tests and multiple logistic regression models with correction for cluster sampling. For variables with missing data we imputed values using multiple imputation by chained equations.

Results Of 16 264 patients participating in the NOGCA in England, 2313 received palliative chemotherapy treatment. Female patients or patients of older age were less likely to receive treatment. Overall, only 39.7% completed their treatment. Factors associated with treatment completion were low performance status, high age and high level of deprivation. In our study, treatment completion was not related with site of cancer, pre-treatment stage, sex, co-morbidities or histology.

Conclusion Completion rates of palliative chemotherapy in patients with oesophago-gastric cancer are low. The low completion rates may reflect the complex medical decision making for this group of patients and the need to balance survival benefits, toxicity of treatment, patients' preferences and patients' quality of life. Patients unlikely to complete chemotherapy may be more appropriately managed on a palliative supportive care pathway with symptom control.

Competing interests None declared.

References 1. Cromwell DA, Palser T, Van der Meulen J, et al. The National Oesophageal-Gastric Cancer Audit: Third Annual Report. London: The Information Centre, 2010.

2. Lord SR, Hall PS, McShane P, et al. Factors predicting outcome for advanced gastroesophageal cancer in elderly patients receiving palliative chemotherapy. Clin Oncol (R Coll Radiol) 2010;22:107–13.

3. Koedoot CG, de Haan RJ, Stiggelbout AM, et al. Palliative chemotherapy or best supportive care? A prospective study explaining patients' treatment preference and choice. Br J Cancer 2003;89:2219–26.

4. Braga S. Why do our patients get chemotherapy until the end of life? Ann Oncol 2011;22:2345–8.

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