Research article
Re-organisation of oesophago-gastric cancer care in England: progress and remaining challenges
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* Corresponding author: David A Cromwell david.cromwell@lshtm.ac.uk
1 Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
2 Health Services Research Unit, Department of Public Health & Policy, London School of Tropical Medicine and Hygiene, Keppel St, London WC1E 7HT, UK
3 Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ, UK
4 Department of Gastroenterology, Northern General Hospital, Herries Road, Sheffield, South Yorkshire S5 7AU, UK
5 National Clinical Audit Support Program, NHS Information Centre for Health and Social Care, 1 Trevelyan Square, Boar Lane, Leeds, LS1 6AE, UK
6 Department of Surgery, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
BMC Health Services Research 2009, 9:204 doi:10.1186/1472-6963-9-204
Published: 12 November 2009Abstract
Background
Oesophago-gastric cancer services in England have been extensively reorganised since 2001 to deliver a centralised, specialist-led service. Our aim was to assess how well the National Health Service (NHS) in England met organisational standards for oesophago-gastric cancer care.
Methods
Questionnaires that asked about the provision of staging investigations, curative and palliative treatments and key personnel were sent in September 2007 to the lead clinician for oesophago-gastric cancer at all 30 cancer networks and 156 NHS acute trusts in England.
Results
Responses were received from all networks and 81% of NHS trusts. All networks provided essential staging investigations and a range of endoscopic palliative therapies. Only 16 of the 30 cancer networks discussed all patients at the specialist multi-disciplinary team meeting and 11 networks had not fully centralised curative surgery. There was also variation between NHS trusts in the integration of the palliative care team, the availability of nurse specialists and the use of dieticians to provide nutritional support.
Conclusion
There has been considerable progress in reforming oesophago-gastric cancer services but the process of reorganisation is still incomplete and regional differences in service provision exist that may lead to variation in patient outcomes.