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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 28, 2008; 14(20): 3165-3173
Published online May 28, 2008. doi: 10.3748/wjg.14.3165
Treatment and survival in a population-based sample of patients diagnosed with gastroesophageal adenocarcinoma
Deirdre P Cronin-Fenton, Margaret M Mooney, Limin X Clegg, Linda C Harlan
Deirdre P Cronin-Fenton, Limin X Clegg, Surveillance Research Program, DCCPS, National Cancer Institute, Bethesda MD 20892-7344, United States
Deirdre P Cronin-Fenton, Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200 Aarhus N, Denmark
Margaret M Mooney, CTEP, DCTD, National Cancer Institute, Bethesda
Linda C Harlan, Applied Research Program, DCCPS, National Cancer Institute, Bethesda MD 20892-7344, United States
Limin X Clegg, Office of Healthcare Inspections, Office of Inspector General, Department of Veterans Affairs, Washington DC 20420, United States
Author contributions: Harlan LC designed research; Cronin-Fenton DP, Clegg LX and Harlan LC analyzed the data; Cronin-Fenton DP, Harlan LC and Mooney MM wrote the paper.
Correspondence to: Dr. Linda C Harlan, Applied Research Program, DCCPS, National Cancer Institute, 6130 Executive Blvd MSC 7344, Bethesda MD 20892-7344, United States. lh50w@nih.gov
Telephone: +1-301-4967085
Fax: +1-301-4353710
Received: September 27, 2007
Revised: April 12, 2008
Accepted: April 19, 2008
Published online: May 28, 2008
Abstract

AIM: To examine the extent of use of specific therapies in clinical practice, and their relationship to therapies validated in clinical trials.

METHODS: The US National Cancer Institutes’ Patterns of Care study was used to examine therapies and survival of patients diagnosed in 2001 with histologically-confirmed gastroesophageal adenocarcinoma (n = 1356). The study re-abstracted data and verified therapy with treating physicians for a population-based stratified random sample.

RESULTS: Approximately 62% of patients had stomach adenocarcinoma (SAC), while 22% had gastric-cardia adenocarcinoma (GCA), and 16% lower esophageal adenocarcinoma (EAC). Stage IV/unstaged esophageal cancer patients were most likely and stage I-III stomach cancer patients least likely to receive chemotherapy as all or part of their therapy; gastric-cardia patients received chemotherapy at a rate between these two. In multivariable analysis by anatomic site, patients 70 years and older were significantly less likely than younger patients to receive chemotherapy alone or chemoradiation for all three anatomic sites. Among esophageal and stomach cancer patients, receipt of chemotherapy was associated with lower mortality; but no association was found among gastric-cardia patients.

CONCLUSION: This study highlights the relatively low use of clinical trials-validated anti-cancer therapies in community practice. Use of chemotherapy-based treatment was associated with lower mortality, dependent on anatomic site. Findings suggest that physicians treat lower esophageal and SAC as two distinct entities, while gastric-cardia patients receive a mix of the treatment strategies employed for the two other sites.

Keywords: Adenocarcinoma, Esophageal adeno-carcinoma, Gastroesophageal, Gastric adenocarcinoma, Survival, Chemotherapy, Radiotherapy