Referral-to-treatment attrition and its impact on outcomes of patients with advanced gastroesophageal cancers.

Abstract

e16504 Background: Advanced gastroesophageal cancers (AGCs) are aggressive tumors. Prior research has demonstrated that patients with poor prognostic cancers are inconsistently or infrequently referred to oncology specialists because of misperceptions that oncologic treatments are futile and do not alter overall outcomes. The aim of this real-world study was to characterize the attrition of patients with AGCs as they proceed through the diagnostic-therapeutic pathway and to assess its impact on survival. Methods: A retrospective population-based analysis was performed using data from the cancer registry and electronic medical records in a large province (Alberta, Canada). Patients diagnosed with AGCs from 2010 to 2017 were included. Details on demographics, setting of referral (outpatient or inpatient), time from referral to consultation to treatment, and modality of treatment (best supportive care, systemic therapy, and/or radiation) were collected. Logistic regression was used to determine factors associated with referral. Cox regression models were constructed to determine factors associated with overall survival (OS). Results: We identified 1,244 patients, of whom 633 (51%) had gastric and 611 (49%) had esophageal cancer. Median age was 67 years (IQR 58-78 years) and 72% were men. In this cohort, 87% were referred to a cancer center, 80% were seen by an oncologist, and only 44% received first-line treatment. Median time from referral to consultation was 13 days and consultation to treatment was 12 days. In logistic regression, advanced age (OR 0.274; 95% CI 0.183-0.412, p<0.0001) and those with a gastric primary (OR 0.437; 95% CI 0.303-0.628, p<0.0001) were less likely to be referred. In Cox regression, receipt of chemotherapy (HR 0.79; 95% CI 0.76-0.83, p<0.0001) and shorter time from consultation to treatment (HR 0.994; 95% CI 0.991-0.997, p<0.0001) were predictive of better OS. The setting of referral (inpatient vs. outpatient) was not significantly associated with OS (HR 1.11; 95% CI 0.85-1.45, p=0.414). Conclusions: Attrition was most significant as patients proceeded from consultation to treatment. Streamlining processes to narrow the consultation to treatment window may increase the number of patients with AGCs who may be eligible for potentially effective therapies or new clinical trials, which can improve their overall outcomes.