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Trends in survival based on treatment modality for esophageal cancer

a population-based study

Akhtar-Danesh, Nooria,b; Shakeel, Saadc; Seow, Hsienb,d; Akhtar-Danseh, Gileh-Gole; Finley, Christianf

European Journal of Gastroenterology & Hepatology: October 2019 - Volume 31 - Issue 10 - p 1192–1199
doi: 10.1097/MEG.0000000000001498
Original Articles: Gastroenterology
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Objectives The primary objective was to examine the trends in treatment modalities and the respective survival rates for esophageal cancer in the province of Ontario, Canada.

Methods This is a population-based study of all esophageal cancer cases diagnosed in Ontario between 2007 and 2015, including squamous cell carcinoma and adenocarcinoma, with known disease stage. Other characteristics include sex, age, date of diagnosis, and treatment modalities. Treatment modalities were classified as no-treatment, radiation only or chemotherapy only, chemoradiation, and surgical resection.

Results In total, 2572 patients were identified with esophageal cancer from 2007 to 2015, of which 2014 (78.3%) were male. The mean age at diagnosis was 66.6 (SD = 11.7) years. Survival rate increased over time in patients who underwent chemoradiation or surgical resection but remained unchanged for the radiation-only or chemotherapy-only group and decreased for the no-treatment group. Survival considerably improved (15–20%) for patients with stages I–III disease.

Conclusions The positive trends in the survival rate for esophageal patients could be due to adoption of multimodal therapy. Despite a lower proportion of advanced disease among patients over 80, they received less curative treatments compared with other age groups. Further studies are required to identify strategies to maximize survival for patients with stage IV disease, and patients 80 years and older.

aSchool of Nursing, McMaster University, Hamilton

bDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton

cSchool of Medicine, University of Toronto, Toronto

dDepartment of Oncology, McMaster University, Hamilton

eDepartment of Surgery, McMaster University, Hamilton

fDivision of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada

Received 11 March 2019 Accepted 14 May 2019

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.eurojgh.com.

Correspondence to Noori Akhtar-Danesh, PhD, School of Nursing, McMaster University, 1280 Main St. West, Room 3N28B, Hamilton, ON L8S 4K1, Canada, Tel: +905 525 9140 x22297; fax: +905 521 8834; e-mail: daneshn@mcmaster.ca

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