Abstract
BackgroundIt is internationally recognised that centralisation of specialist cancer services results in improved oncologic outcomes, particularly for rare cancers. Ireland’s oncology services were formally centralised into 8 high volume cancer centres in 2007. We sought to identify changes in the utilisation of cancer treatment modalities and outcomes for patients with hepatobiliary cancers in Ireland pre and post centralisation. MethodsFollowing local ethics board approval, anonymised patient data was provided by the National Cancer Registry of Ireland (NCRI) regarding all cases of hepatocellular cancer (HCC), cholangiocarcinoma and gallbladder cancers (ICD10: C22, C23 and C24) diagnosed in Ireland between 2000 – 2016. Data analysis was completed in collaboration with the NCRI. ResultsData from 5733 patients with cholangiocarcinoma, gallbladder cancer and HCC over 16 years were analysed (Table). Similar rates of resection of all cancers were identified (21% pre 2008 and 24% from 2008 -2016). Overall 5-year survival for all cancers evaluated was significantly higher (non-overlapping CI) from 2008 -2016 - 16.1% (95% CI 14.4-17.8%) compared to pre 2008 - 12.6% (95% CI 11.0-14.4%). Despite similar rates of resection, 5-year survival rates for all resected cancers was significantly improved from 2008 - 2016 - 46.0% (95% CI 41.3-50.6%) vs 35.7% (95% CI 30.7-40.6%) prior to this. The most significant changes in use of treatment modality over the time course studied was the number of patients who received chemotherapy only (9% pre 2008 and 19% 2008 -2016, p<0.01) and the significant increase in the number of patients who underwent adjuvant treatment (21% pre 2008 versus 42% from 2008 - 2016, p<0.01).Table740PTableCancer Subtypes2000-20072008-2016Cholangiocarcinoma38% (782)41% (1519)Hepatocellular Carcinoma17% (346)21% (780)Gallbladder19% (379)13% (497)Unspecified Subtype26% (537)24% (893)Total20443689 ConclusionsThe establishment of national cancer centres in Ireland in 2007 was associated with improvement in 5-year survival for patients with hepatobiliary malignancies and with increased utilisation of systemic therapy in the advanced and adjuvant settings. Legal entity responsible for the studySt. James’ Hospital, Dublin. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.
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