PWE-035Centralisation of upper GI cancer services-is the hub really better than the spoke?

• Published in: Gut Vol. 61; no. Suppl 2; p. A311
• Main Authors: Monkhouse, S, Torres-Grau, J, Bawden, D, Ross, C, Krysztopik, R
• Format: Journal Article
• Language: English
• Published: 01.07.2012
• ISSN: 0017-5749
• DOI: 10.1136/gutjnl-2012-302514d.35

IntroductionThe aim of this study was to assess whether patients diagnosed with oesophageal or gastric cancer at a local district general hospital (the "spoke") have a similar temporal pathway through the decision making and treatment process compared to those patients presenting at the centralised, tertiary hospital (the "hub").MethodsBetween April 2010 and April 2011, patients with a new diagnosis of oesophago-gastric cancer from both the hub and spoke hospitals were analysed. Data regarding diagnosis, time from diagnosis to multidisciplinary meeting (MDM) discussion and time from MDM decision to first treatment were all recorded. Statistical analysis was performed using parametric two-tailed t-test to assess significance.ResultsThere was a statistically significant increase in the time from diagnosis to MDM discussion at the spoke hospital compared to the hub (13.3days vs +25.67days; p=0.001). However, time to first treatment (surgery, palliative therapy, neo-adjuvant therapy or best supportive care) was significantly increased in the hub hospital compared to the spoke (43.4days vs 25.5days; p=0.023).ConclusionThis study is the first of its kind to show that there is a disparity in the management pathways of patients who first present to a regional hospital rather than the tertiary centre. Patients at the spoke hospital have a longer lead time into the MDM but non-operative treatment appears to be delivered more quickly locally.Competing interestsNone declared.References1. Polednak AP. "Trends in survival for both histologic types of esophageal cancer in US surveillance, epidemiology and end results areas". Int J Cancer 2003; 105:98-100.2. Birkmeyer JD, Stukel TA, Siewers AE, et al. Surgeon volume and operative mortality in the United States. N Engl J Med 2003; 349:2117-27.3. Gill AJ, Martin IG. Survival from upper gastrointestinal cancer in New Zealand: the effect of distance from a major hospital, socio-economic status, ethnicity, age and gender. ANZ J Surg 2002; 72:643-6.4. Department of Health. Improving Outcomes in Upper Gastrointestinal Cancers. London: Department of Health, 2001.5. Siriwardena AK. Centralisation of upper gastrointestinal cancer surgery. Ann R Coll Surg Engl 2007; 89:335-6.6. Siewert JR, Stein HJ. Carcinoma of the gastroesophageal junction: classification, pathology and extent of resection. Dis Esophagus 1986; 9:173-82.7. Mcleod U, Mitchell ED, Burgess C, et al. Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. Br J Cancer 2009; 101(Suppl 2):S92-101.8. Forshaw MJ, Gossage JA, Stephens J, et al. Centralisation of oesophagogastric cancer services-can specialist units deliver? Ann R Coll Surg Engl 2006; 88:566-70.