Understanding Unwarranted Variation in Care for Victorian Oesophagogastric Cancer Patients Using Linked Data: A Comparative Analysis Between 2012-2016 and 2017-2021.

Background: The Victorian Integrated Cancer Services convened the second Oesophagogastric (OG) Cancer Optimal Care Summit to determine unwarranted variation in care between 2017 and 2021 and compare trends with the first summit (reporting 2012-2016). Statewide administrative datasets were assessed retrospectively at the population level in alignment with the optimal care pathway steps for OG.

Methods: Victorians with a primary diagnosis of OG cancer were identified via the Victorian Cancer Registry dataset and linked to various administrative datasets to identify unwarranted variations.

Results: Of the 9868 Victorians diagnosed with OG cancer between 2012 and 2021, 39.4% were metastatic at diagnosis. Improved outcomes between time periods included reduced mortality for OG cancer and post-surgical mortality 1 year post gastrectomy. Patient multidisciplinary meeting presentation increased from 74% to 86%. Unwarranted variations included time from diagnosis to any treatment within 6 weeks for non-metastatic gastric cancer (64%, 2012-2016 and 60%, 2017-2021) and for oesophageal cancer patients (58%, 2012-2016 and 60%, 2017-2021). One regional Integrated Cancer Service (ICS) demonstrated statistically lower survival compared to the statewide average for gastric cancer in 2017-2021. There was greater variation in survival for gastric cancer for 2017-2021 compared to 2012-2016. Rates of dietitian and/or physiotherapist involvement within 3 months of diagnosis for OG cancer surgical and/or chemotherapy patients were low across all ICS and both time periods.

Conclusions: The Victorian cancer system demonstrates improved survival outcomes for OG cancer patients between the two time periods. Time between diagnosis and treatment, lower survival rates in some ICS, and access to supportive care (e.g., dietetics and physiotherapy) remain areas of deficiency.