Management of gastric cancer in Ontario

Objective: To describe the processes of care for gastric cancer in Ontario and identify areas in which care and possibly survival can be improved.

Summary background data: Survival in North America is poor for patients with gastric cancer, with stage-matched survival markedly worse than is seen in Asian and European series. Few Western studies have examined processes of care associated with gastric cancer.

Methods: We identified all cases of gastric cancer in Ontario, Canada from April 1, 2000 to March 31, 2005, and describe the demographics of patients, staging of the cancer, treatment, and survival.

Results: In this series of 3,666 patients, 81% of cases had a CT scan performed prior to resection and 90% of cases received an upper endoscopy. We found that 55% of patients were treated palliatively and only 1,645 patients underwent a curative-intent resection. Among patients who did not receive a resection over 50% of the cases appeared to have had a diagnostic laparoscopy rather than a laparotomy. Survival was related to the type of resection performed, likely reflecting the extent of disease. Higher institution volume and age were related to improved survival for curative-intent cases.

Conclusion: In this population-based analysis, we found evidence of under-utilization of pre-operative radiology and endoscopy. Many patients were treated palliatively, reflecting presentation of the cancer at an advanced stage. For curative patients, survival was associated with age, surgical type, and resection in a higher volume institution.