How appropriate is treating patients diagnosed with advanced esophageal cancer with anticancer drugs? A multicenter retrospective cohort Spanish study

• Marilina Santero ^[4] ; Carolina Requeijo ^[4] ; Maria Jesus Quintana ^[4] ; Xavier Bonfill Cosp ^[4] ; Iratxe Urreta Barallobre ^[5] ; Dulce Rodríguez ^[1] ; David Bottaro ^[1] ; Ismael Macias ^[2] ; Carles Pericay ^[2] ; Natalie Farina ^[3] ; Jesus Manuel Blanco ^[3] ; Laura Punti ^[6] ; Maria Angeles Nava ^[6]
  1. [1] Hospital Universitari Sant Joan de Reus

     Hospital Universitari Sant Joan de Reus

     Reus, España

     
  2. [2] Corporació Sanitària Parc Taulí

     Corporació Sanitària Parc Taulí

     Barcelona, España

     
  3. [3] Hospital Universitario de Donostia

     Hospital Universitario de Donostia

     San Sebastián, España

     
  4. [4] Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma Barcelona (UAB), Barcelona, Spain
  5. [5] Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
  6. [6] Clinical Epidemiology Unit, Osakidetza Basque Health Service, Donostia University Hospital, Donostia-San Sebastián, Spain

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 26, Nº. 10, 2024, págs. 2629-2639
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Aim To assess the appropriateness of systemic oncological treatments (SOT) provided to patients diagnosed with advanced esophageal cancer (EC) across a group of participating hospitals.

    Methods Multicenter, retrospective cohort study in five Spanish hospitals including newly confirmed advanced EC cases between July 1, 2014, and June 30, 2016, with a 5-year follow-up.

    Results We identified 157 patients fulfilling the inclusion criteria (median age: 65 years, 85.9% males). Most patients, 125 (79.6%) were treated at least with one active treatment, and 33% received two or more lines of SOT. The 1-, 2- and 5-year overall survival rates were 30.3% [95%CI: 23.8, 38.7], 14.0% [95%CI: 9.3, 21.0], and 7.1% [95% CI: 3.8, 13.1] respectively, and the median survival time 8 months (95% CI: 6, 19) for stages IIIb IIIc and 7 months (95% CI: 5, 9) for stage IV. Clinical stage, receiving more than one line of SOT, and treatment with radiotherapy accelerated the time to death (0.4, 0.9-, and 0.8-times shorter survival respectively, p < 0.05). Better performance status (ECOG < 2) extended survival time by 2.2 times (p = 0.04). Age < 65 years (OR 9.4, 95% CI 3.2, 31.4, p < 0.001), and being treated in one particular hospital (OR 0.2, 95% CI 0.0, 0.8, p < 0.01) were associated with the administration of two or more lines of SOT. Altogether, 18.9% and 9.0% of patients received chemotherapy in the last four and two weeks of life, respectively. Moreover, 2.5% of patients were prescribed a new line of chemotherapy during the last month of life. The proportion of all patients who did not have access to palliative care reached 29.3%, and among those who had access to it, 34.2% initiated it in the last month of life.

    Conclusion A high proportion of advanced EC patients receive many treatments not based on sound evidence and they do not benefit enough from palliative care services. The most accepted appropriateness indicators point out that some of the analyzed patients could have been overtreated. This study provides important insights into the quality of care provided to advanced EC, and furthermore, for giving valuable insight and opportunities for improvement.