Unwarranted variations in oesophagogastric cancer care and outcomes

The VICS Optimal Care Summits program has identified 20 ‘unwarranted variations’ in oesophagogastric cancer care and outcomes in Victoria.

An unwarranted variation is a difference not explained by differences in illness or preferences – that is, a chance to improve the quality and equity of clinical care.

The VICS use a mixed-methods approach used to identify and prioritise such variations, including:

• linked health data and analysis from the Department of Health
• a rapid literature review
• analysis of general practice variations
• surveying the Victorian health workforce re barriers, enablers and preferences
• consumer engagement to collect and summarise lived experience.

Variations 1–3 below were prioritised for discussion at a live summit event on 1 March 2024, with nearly 100 expert stakeholders from different disciplines involved in oesophagogastric (OG) cancer care.

For full details of each variation, see pp 6–7 of our prioritisation report (PDF).

1. Different survival among patients living in some regional areas, compared to the statewide average, for non-metastatic gastric cancer
2. Variations in time from diagnosis to patients receiving any treatment within 6 weeks for non-metastatic oesophageal cancer
3. Low rates of OG cancer surgical and/or chemotherapy patients being seen by a dietitian within 3 months of diagnosis
4. Increasing variation in overall survival for gastric cancer based on where patients live
5. Low rates of OG cancer patients receiving palliative care at least 3 months before death
6. Poorer survival among metastatic gastric cancer patients living in the Loddon Mallee region, compared to those in metropolitan areas
7. Differences in incidence of oesophageal cancer between metropolitan areas and most regional areas (standardised for age)
8. Different numbers of oesophageal cancer patients diagnosed with metastatic disease at diagnosis, based on where patients live
9. Variations between health services in the percentage of OG cancer patients that are discussed at multidisciplinary meetings (MDMs)
10. Variations in recording cancer staging information in MDMs
11. Variation in how many patients receive chemo/radiotherapy within a year of diagnosis with non-metastatic oesophageal cancer, based on where patients live
12. Variation in how many patients receive chemo/radiotherapy within a year of diagnosis with non-metastatic gastric cancer, based on where patients live
13. Low rates of OG cancer patients with metastatic disease having an advance care directive on record
14. Low rates of OG surgical and chemotherapy patients being seen by a physiotherapist within 3 months of diagnosis
15. Low and decreasing proportions of partial-gastrectomy patients, at some surgical campuses, who stay in hospital 10 days or less
16. Increasing proportion of patients presenting to an emergency department within 28 days prior to diagnosis of oesophageal cancer.
17. 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)
18. An increasing proportion of patients with non-metastatic OG cancer, who had a gastrectomy and were given neoadjuvant chemotherapy
19. A minor increase in the proportion of OG cancer patients who had an emergency admission within 30 days prior to death
20. No change overall in age-standardised incidence of OG cancer.

For details of how these variations apply to specific Integrated Cancer Service (ICS) regions and member health services, contact your local ICS.

Themes raised at the summit included improving access to diagnostics and treatment, improving care coordination and navigation, facilitating access to data and information and supporting the workforce.

A register of actions, proposed by the VICS and our partners to address the 3 highest-priority variations, will be shared with health services and published shortly.

The VICS, through each ICS’ deep connections in their region, will support health services and other providers to implement recommendations and address other variations as applicable.