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Treatment selection for esophageal cancer: evaluation from a nationwide database

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Abstract

Background

Most elderly patients poorly tolerate the standard treatment for esophageal cancer; however, little information is available regarding the appropriateness of non-standard esophageal cancer treatments for those patients. This study aims to analyze the treatment costs and completion rates of patients undergoing a real-world treatment for esophageal cancer to elucidate the treatment selection and its quality.

Materials and methods

We analyzed treatment costs and completion rates for patients with esophageal cancer and analyzed these data relative to patient age and center volumes. Patients with esophageal cancer [UICC, TMN, Clinical stage II/III (excluding T4)] who were diagnosed in 2013 were analyzed. Patients were classified into five groups defined as follows: surgical therapy, chemotherapy, concurrent chemoradiotherapy (CCRT), modified concurrent chemoradiotherapy (mCRT), and radiotherapy (RT).

Results

Mean and median age of patients who received surgery and CCRT were comparable; however, patients who underwent mCRT and RT tended to be older. Medical costs associated with surgery were higher than costs associated with other non-surgical treatments. Cost and completion rate of chemoradiotherapy did not differ between CCRT and mCRT; however, both had higher completion rates compared to that of RT. Surgical expenses tended to be the highest in low-volume centers and the lowest in high-volume centers.

Conclusion

Treatment of esophageal cancer at high-volume centers seems well balanced compared with medium- to low-volume centers. mCRT was widely performed and comparable in medical cost to CCRT, although additional clinical impacts were unclear.

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Abbreviations

DPC:

Diagnosis Procedure Combination

CCRT:

Concurrent chemoradiotherapy

mCRT:

Modified concurrent chemoradiotherapy

RT:

Radiotherapy

DCCH:

Designated Cancer Care Hospitals

HBCR:

Hospital-based cancer registries

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Author information

Authors and Affiliations

  1. Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji Chuoh-ku, Tokyo, 104-0045, Japan

    Yasuo Hamamoto, Naoki Sakakibara & Takahiro Higashi

  2. Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan

    Yasuo Hamamoto

  3. Department of Medical Oncology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan

    Fumio Nagashima

  4. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Yuko Kitagawa

Authors
  1. Yasuo Hamamoto
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  2. Naoki Sakakibara
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  3. Fumio Nagashima
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  4. Yuko Kitagawa
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  5. Takahiro Higashi
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Corresponding author

Correspondence to Yasuo Hamamoto.

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Ethical Statement

Authors declare that our work conforms to the guidelines set forth in the Helsinki Declaration of 1975, as revised in 2000, concerning Human and Animal Rights, and that they followed the policy concerning Informed Consent.

Conflict of interest

Naoki Sakakibara, Fumio Nagashima, and Takahiro Higashi have no conflicts of interest. Yasuo Hamamoto has conflicts of interest to declare with regard to this manuscript: Ono Pharmaceutical Co. Yuko Kitagawa has conflicts of interest to declare with regard to this manuscript: Ethicon, Ono Pharmaceutical Co., Taiho Pharma, Chugai Pharmaceutical co., Asahi Kasei Pharma, Otsuka Pharmaceutical Co., Kyowa Hakko Kirin Co., Daiichi Sankyo co., Takeda Pharmaceutical Co. Nippon Boehringer Ingelheim Co., Novartis Pharma., Pfeizer Japan, Merck Serono Co., Yakult Honsha co., Terumo Corporation, Torii Pharmaceutical Co., Astra Zeneca.

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Hamamoto, Y., Sakakibara, N., Nagashima, F. et al. Treatment selection for esophageal cancer: evaluation from a nationwide database. Esophagus 15, 109–114 (2018). https://doi.org/10.1007/s10388-018-0605-0

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  • DOI: https://doi.org/10.1007/s10388-018-0605-0

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