Patients who have curative surgery for oesophago-gastric cancer have a lower risk of death in hospital following their operation compared to eight years ago, according to new findings released today by the National Oesophago-Gastric Cancer Audit.

Overall, in-hospital mortality after surgery in England and Wales is now 4.5 per cent for oesophageal cancer patients and 6.0 per cent for stomach cancer patients according to the audit, which collected information on 3,612 curative operations. A previous audit of patients who had surgery between 1999 and 2002 found in-hospital mortality rates for these oesophageal and stomach operations of 14 per cent and 10 per cent respectively.

The latest audit, commissioned by the Healthcare Quality Improvement Partnership, is a collaboration between The Association of Upper GI Surgeons (AUGIS), The British Society of Gastroenterology (BSG), The NHS Information Centre and Royal College of Surgeons of England.

It also looked at the treatments received by patients who had advanced disease and could not have curative surgery. Options include palliative chemotherapy, palliative radiotherapy, the insertion of stents and treatments to alleviate pain and other symptoms.

Around half of palliative treatment plans included palliative chemotherapy or radiotherapy, which reflects improved access overall. Whether these options are suitable for patients depends upon the severity of their disease and their fitness levels.

The use of palliative chemotherapy and radiotherapy varied between cancer networks, with the proportion of patients with these planned therapies typically varying between 34 and 54 per cent. Some of the variation is explained by differing proportions of patients suitable for such therapies by cancer network. However the audit recommends that cancer networks review how palliative treatments are planned.

Each year, in England and Wales, approximately 13,500 people are diagnosed with either oesophageal or gastric cancer, making it the fifth most common type of cancer. The condition typically afflicts more elderly people and the prognosis for survival is poor with overall five-year survival rates in England and Wales, around 10 per cent for oesophageal cancer and 15 per cent for gastric cancer. The audit collected information on 17 000 patients who were diagnosed with these cancers between 1 October 2007 and 30 June 2009.

Richard Hardwick, Consultant Surgeon and member of the Association of Upper GI Surgeons (AUGIS), said “Centralising oesophageal and gastric cancer care in the UK has been difficult but some early benefits are now being seen. Postoperative mortality has been halved. We now have some of the best surgical services in Europe for treating this terrible disease.”

Stuart Riley, Consultant Gastroenterologist and member of The British Society of Gastroenterology (BSG), said “It is gratifying to see improvements in surgical outcomes for patients with oesophago-gastric cancer. However most patients still present with advanced disease and we now need to concentrate our efforts on improving early diagnosis and optimising oncological and palliative interventions.”

The full version of the Third Annual Report is at: www.ic.nhs.uk/ogreports

ENDS

Notes to editors

1. Cancer Networks bring together health service commissioners and providers, the voluntary sector and local authorities. Typically a network services a population of around one to two million people. They were created as a result of recommendations made in the Calman Hine Report (1995).
2. For results from previous audit, see: McCulloch P, Ward J, Tekkis PP. Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ 2003; 327: 1192-7.
3. Service provision for oesophago-gastric cancer is described in Department of Health. Guidance on Commissioning Cancer Services: Improving Outcomes in Upper Gastro-Intestinal Cancers: The Manual. London: Department of Health, 2001.
4. The principal aim of palliative care is to improve patient quality of life by alleviating pain and controlling other symptoms as well as providing psychological and social support. Palliative treatments essentially fall into three groups: conservative (best supportive care), oncological (chemotherapy, radiotherapy or a combination of the two) or endoscopic / radiological (stenting, thermal ablation and brachytherapy). Patients with stomach cancers that are obstructing the passage of food may also have palliative surgery to remove the obstruction.
5. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.
6. The NHS Information Centre for health and social care (The NHS IC) is England's authoritative, central, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researcher, regulators and policymakers in their work. The NHS IC also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
7. The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808. For more information please visit www.rcseng.ac.uk
8. For media enquiries please contact The NHS Information Centre on 0845 2576990 or mediaenquiries@ic.nhs.uk