Regional variation in the management of metastatic gastric cancer in Ontario

Background — Geographic variation in cancer care is common when clear clinical management guidelines do not exist. This study sought to elucidate healthcare resource consumption by metastatic gastric cancer (GC) patients, and investigate the possibility of regional variation.

Methods — In this population-based cohort study of stage IV gastric adenocarcinoma patients diagnosed between 04/01/2005 and 03/31/2008, chart review and administrative healthcare data were linked to study resource utilization outcomes (e.g. clinical investigations, treatments) in the province of Ontario, Canada. This study was performed from the healthcare system perspective, using a two-year time frame. Chi square tests were used to compare proportions of resource utilization, and ANOVA compared per patient mean usage between geographic regions.

Results — A cohort of 1433 patients received 4690 endoscopic investigations, 12033 computed tomography scans, 12,774 x-rays and 5059 ultrasounds. Nearly all patients were seen by a general practitioner (98%), a specialist (99%), were hospitalized (95%) or visited the emergency department (ED) (87%). Fewer than half received chemotherapy (43%), gastrectomy (37%) or radiotherapy (28%). The mean number of clinical investigations, physician visits and hospitalizations, and whether or not a patient accessed the ED or received radiotherapy or stent placement varied significantly by region.

Conclusions— Variations in healthcare resource utilization exist across regions of Ontario among metastatic GC patients. Whether these differences reflect differential access to resources, patient preference or physician preference is not known. This variation may reflect the lack of guidelines based on high-quality evidence, and may be partially ameliorated through regionalization of GC care to high-volume centres.