OGC P65 Diagnostic workup for esophageal cancer patients can be improved with checklists and clearer protocols; a comparative study between two tertiary centers in Europe

Abstract

Abstract Background Rapid and complete workup of newly diagnosed esophageal cancer is vital for a timely, individual and high-quality treatment strategy. The aim of this study was to uncover potential delay, inefficiencies and non-contributing investigations in the diagnostic process. Methods This retrospective cohort study included all newly diagnosed esophageal cancer patients referred to or diagnosed in the Amsterdam UMC and Karolinska University Hospital between July 2020 and July 2021. Radiology, pathological assessment and multidisciplinary team meeting reports were reviewed. To assess time interval from diagnosis to treatment, dates of diagnosis, admittance to referral hospital, MDT meeting and start of treatment were collected. Results In total, 252 esophageal cancer patients were included, of which 187 were treated with curative intent. Curatively treated patients had a mean age of 66 years, were predominantly male (74.9%) with an adenocarcinoma (71.4%). Curatively treated patients had a median time from diagnosis to referral of seven days (IQR:0-11) and a median of 35 days (IQR:28-45) between diagnosis and start treatment. 69 patients had a prolonged time, defined as 40 days or more, between diagnosis and treatment. Main reasons for differences in time between diagnosis and treatment between centers, Amsterdam UMC (39 days) vs Karolinska (27 days), were additional diagnostics (47.8%) and differences in referral routine. For 27 out of 67 patients (40.3%) only logistical reasons were found for prolonged time between diagnosis and treatment. Conclusions Time between diagnosis and treatment can be improved, possibly with alterations in workup protocol, referral routines, MDT meeting regulations and workup checklists.