Background: The Victorian Integrated Cancer Services (VICS) Optimal Care Summits (OCS) program engages clinicians and consumers in identifying unwarranted variations in cancer care and outcomes against Optimal Care Pathways (OCP).
Aim: To determine Victorian unwarranted variations in oesophagogastric (OG) cancer compared to the OCP, across two periods.
Methods: This is a population-level retrospective analysis of Victorians with a primary diagnosis of OG cancer between 2012 and 2021, identified via the Victorian Cancer Registry dataset. Data were drawn from multiple linked administrative datasets including the Victorian Admitted Episodes Dataset, Radiotherapy Minimum Dataset, Emergency Minimum Dataset, and Victorian Death Index. These datasets provided information on demographics, tumour and treatment characteristics, and measures aligned with OCP standard.
Results: Improved outcomes between the time periods included reduced mortality one year post gastrectomy. The proportion of oesophageal cancer patients that received chemotherapy locally increased from 79 to 81%. 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) lower than the OCP standards. One regional ICS demonstrated a statistically different survival compared to the statewide average for gastric cancer in 2017-21. There was greater variation in survival for gastric cancer for 2017-21 compared to 2012-2016. A new indicator showed on average, only 58% of OG cancer surgical and/or chemotherapy patients were seen by a dietitian within 3 months of diagnosis between 2017-2021.
Conclusions: There are unwarranted variations for OG cancer care in Victoria. Despite some improvements across the two periods, targeted action is required to address these variations including lower survival rates in some ICS.