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Gastric cancer patients receive different treatment depending on region: Ontario study

August 8, 2016 Toronto

A new study from the Institute for Clinical Evaluative Sciences (ICES) and Sunnybrook Health Sciences Centre shows that Ontario patients being treated for gastric cancer receive different care depending on where they live. The researchers say their findings demonstrate that more equitable approaches are needed across the province for this particularly lethal cancer.

“While differences in patient preference and disease characteristics could account for some treatment variation at the individual level, our study shows that these differences are identifiable at the regional level,” says Dr. Natalie Coburn, the lead scientist on the study who is an adjunct scientist at ICES and a surgical oncologist at Sunnybrook’s Odette Cancer Centre. “It stands to reason that without treatment guidelines for these patients, institutions and specialists may be determining their own approaches, resulting in regional differences in care costs, and most importantly, differences in patient outcomes.”

Coburn is leading the creation of gastric cancer guidelines for Ontario, sponsored by the program in evidence-based care at Cancer Care Ontario.

Gastric cancer is one of the most costly and complex cancers to treat. Management of the disease often includes a surgical team, chemotherapy and radiation as well as significant nutritional support, with estimated direct health care costs of approximately $42,000. The prognosis for gastric cancer is particularly poor: in 2009, nearly 1,200 Ontario patients were diagnosed with the disease, and over 750 patients died, as the majority presented with Stage IV disease.

Published today in the journal Current Oncology, the study examined anonymized health records for 1,433 stage IV gastric adenocarcinoma patients diagnosed in Ontario between 2005 and 2008.

Among the study’s findings:

  • There were regional differences in the number of clinical investigations, physician visits and hospitalizations, as well as how many times a patient accessed the emergency department or received home care.
  • Whether a patient saw at least one high volume gastric cancer specialist differed based on LHIN of residence, ranging from zero to 47 per cent.
  • There were differences in regional rates of gastrectomy, from 32 per cent in one LHIN to 53 per cent in another.
  • Region was also a factor in whether a patient had a stent placement, ranging across LHINs from 2 per cent to 12 per cent.
  • There were regional differences in rates of radiotherapy, from 18 per cent to 41 per cent across LHINs.
  • There were also regional differences in diagnostic and investigational procedures, including the use of MRI, ultrasound and CT scans.

“Given the high costs of many of these procedures, we need to investigate why there is so much regional variation in their use, and if they are clinically warranted,” comments Coburn.

This paper follows previous work by the same team of researchers published in Gastric Cancer that found significant regional variation in survival rates of stage IV gastric cancer patients.

"From our earlier study we know that where a patient lives and receives gastric cancer care in Ontario can have an impact on his or her mortality,” says Coburn. “These new findings will help us to address those care gaps, by identifying where in the system they are occurring, so we can find solutions that will make treatment access more equitable across the province.”

“Regional variation in the management of metastatic gastric cancer in Ontario” was published today in the journal Current Oncology.

Author block: A. L. Mahar, N. G. Coburn, D. J. Kagedan, R. Viola., A. P. Johnson.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

Sunnybrook Health Sciences Centre is inventing the future of health care for the 1.2 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The Hospital also has a unique and national leading program for the care of Canada’s war veterans. For more information about how Sunnybrook is inventing the future of health care please visit us online at www.sunnybrook.ca

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