VICS Optimal Care Summits oesophagogastric cancer consultation 2023–2024
The second consultation on oesophagogastric cancer for the VICS Optimal Care Summits was held in 2023–24.
The expert advisory group below used a mixed-methods approach to analyse new data and efforts to improve equity of care since our 2016 consultation on the same topic. They identified and prioritised 20 unwarranted variations in oesophagogastric cancer care and outcomes:
Unwarranted variations
Variations 1–3 below were prioritised for discussion at a live summit event on 1 March 2024, with 95 expert stakeholders from different disciplines involved in oesophagogastric or upper gastrointestinal (upper GI) cancer care.
For full details of each variation, see pp 6–7 of our prioritisation report (PDF).
- Different survival among patients living in one region, compared to the statewide average, for non-metastatic gastric cancer
- Variations in time from diagnosis to patients receiving any treatment within 6 weeks for non-metastatic oesophageal cancer
- Low rates of oesophagogastric (OG) cancer surgical and/or chemotherapy patients being seen by a dietitian within 3 months of diagnosis
- Increasing variation in overall survival for gastric cancer based on where patients live
- Low rates of OG cancer patients receiving palliative care at least 3 months before death
- Poorer survival among metastatic gastric cancer patients living in the Loddon Mallee region, compared to those in metropolitan areas
- Differences in incidence of oesophageal cancer between metropolitan areas and most regional areas (standardised for age)
- Different numbers of oesophageal cancer patients diagnosed with metastatic disease at diagnosis, based on where patients live
- Variations between health services in the percentage of OG cancer patients that are discussed at multidisciplinary meetings (MDMs)
- Variations in recording cancer staging information in MDMs
- Variation in how many patients receive chemo/radiotherapy within a year of diagnosis with non-metastatic oesophageal cancer, based on where patients live
- Variation in how many patients receive chemo/radiotherapy within a year of diagnosis with non-metastatic gastric cancer, based on where patients live
- Low rates of OG cancer patients with metastatic disease having an advance care directive on record
- Low rates of OG surgical and chemotherapy patients being seen by a physiotherapist within 3 months of diagnosis
- Low and decreasing proportions of partial-gastrectomy patients, at some surgical campuses, who stay in hospital for 10 days or less
- Increasing proportion of patients presenting to an emergency department within 28 days before diagnosis of oesophageal cancer
- For some patients who receive a gastrectomy, variation in the length of stay depending on the location of their surgery (Some surgical campuses are below the Victorian average)
- An increasing proportion of patients with non-metastatic OG cancer, who had a gastrectomy and were given neoadjuvant chemotherapy
- A minor increase in the proportion of OG cancer patients who had an emergency admission within 30 days before death
- No change overall in age-standardised incidence of OG cancer.
For details of how these variations apply to specific Integrated Cancer Service (ICS) areas and member health services, contact your local ICS.
VICS Optimal Care Summits
Action register
The Victorian Oesophagogastric Cancer Action Register 2024 (PDF) captures 19 actions that the expert advisory group below recommended be prioritised by the VICS and by individual Integrated Cancer Services (ICS), to address the unwarranted variations above at state, network, and health service levels.
The register also captures work being led by other key cancer stakeholders – the Victorian Department of Health, Cancer Council Victoria, Data Connect, and The Pancare Foundation – that may have direct and indirect impacts on the identified unwarranted variations.
Advisory group
- A/Prof. Paul Cashin (Co-chair) – Upper GI Surgeon, Service Director General and Gastrointestinal Surgery, Monash Health
- Dr David Liu (Co-chair) – Oesophagogastric Cancer Surgeon, Austin Health
- Dr Andrew Barling – Consultant Surgeon, Bendigo Health
- Wendy Brown – Head of Unit, Alfred Health, Oesophagogastric Bariatric Unit; Program Director of Surgical Services Alfred Health; Chair, Monash University Dept of Surgery, Alfred Health
- Dr Julie Chu – Radiation Oncologist, Peter MacCallum Cancer Centre
- A/Prof. Cuong Duong – Upper GI surgeon, Peter MacCallum Cancer Centre
- Dr Andrew Haydon – Medical Oncologist, Alfred Health
- Dr George Iatropoulos – Medical Oncologist, Western District Health Service Hamilton Cancer Centre
- Ms Kelly Koschade – Palliative Care Nurse Practitioner, Palliative Care Consultancy, Gippsland
- Dr Margaret Lee – Medical Oncologist, Eastern Health
- Dr Lizzie Lim – Medical Oncologist, Ballarat Regional Integrated Cancer Centre
- A/Prof. Lara Lipton – Medical Oncologist, Western Health and Cabrini Health
- Dr Craig MacLeod – Radiation Oncologist, GenesisCare
- Ms Lisa Murnane – Senior Dietitian, Department of Oesophagogastric and Bariatric Surgery, Alfred Health
- A/Prof. Simon Nazaretian – Anatomical Pathologist, Alfred Health
- Dr Ayesha Saqib – Medical Oncologist, Goulburn Valley Health
- Dr Andrew Tauro – Nuclear Medicine Physician, Austin Health
- Prof Niall Tebbutt – Director, Medical Oncology, Austin Health
- Dr Mark Warren – Medical Oncologist, Bendigo Health Oncology Unit.
