Centralisation of upper-GI cancer services: is the hub quicker than the spoke?

Abstract

The aim of this study was to assess whether patients diagnosed with oesophageal or gastric cancer at a local district general hospital (the "spoke") have a similar temporal pathway through the decision-making and treatment process compared to those patients presenting at the centralised, tertiary hospital (the "hub"). Between April 2010 and April 2011, patients with a new diagnosis of oesophagogastric cancer from both hub and spoke hospitals were analysed. Data regarding diagnosis, time from diagnosis to multidisciplinary meeting (MDM) discussion, and time from MDM decision to first treatment were all recorded. Statistical analysis was performed using parametric two-tailed t test to assess significance. There was a statistically significant increase in the time from diagnosis to MDM discussion at the spoke hospital compared to the hub (13.3 days vs. 25.67 days; p = 0.001). However, time to first treatment (surgery, palliative therapy, neoadjuvant therapy, or best supportive care) was significantly increased in the hub hospital compared to the spoke (43.4 days vs. 25.5 days; p = 0.023). Notwithstanding its limitations, this study is the first of its kind to show that there is a disparity in the management pathways of patients who first present to a regional hospital rather than the tertiary centre. Patients at the spoke hospital have a longer lead time into the MDM but nonoperative treatment appears to be delivered more quickly locally.