Improving gastric cancer survival: Development and measurement of quality indicators using the RAND/UCLA appropriateness method and population-based data analysis

asons that are unclear, the survival following gastric cancer surgery in North America is markedly worse than the results reported in Asia and Europe. Because there are no guidelines or strong evidence to support best practice for gastric cancer surgery, Dr Coburn will review the literature and have a panel of experts grade scenarios to judge the appropriateness of care regarding issues in the surgical treatment of gastric cancer. The overall objective is to improve surgical care for patients with gastric cancer by examining the components of optimal staging and surgical treatment of patients. This information can also be used to determine areas in which care can be improved and to create algorithms for physicians who care for patients with gastric cancer. Previous research: Large case series of patients resected in European and Asian institutions show much better survival following surgery than studies from North America. The reasons for better survival in Asia and Europe may be high volume surgeons performing the resection, more aggressive surgery, better staging, or differences in biology of the disease that have not yet been elucidated. The issue of improved outcomes for cancer patients who are treated at higher volume centres is heavily confounded by the resources that are available at these higher volume centres, and the training of the surgeons who work at these centres. The availability of intensive care units, interventional radiology, and multi-disciplinary teams may be important to the care of gastric cancer patients, especially ones with more complex resections. No study to date has examined what services should be available in a hospital where these complex resections are performed. Although there have been 2 randomized trials examining the issue of aggressive surgery, both trials are criticized heavily because of the exact surgical technique used, and the lack of experience of the surgeons in the trials. Population-based studies in the United States and Canada show that in general, staging of patients is very poor, which may be a result of lack of knowledge on behalf of surgeons and pathologists for this complex disease. Project description: The basic methodology to be used has been well described as the RAND/UCLA Appropriateness Method. Dr Coburn will conduct a literature review focused on surgical treatment of gastric cancer, including the staging, surgical technique used, and institutional requirements for these complex resections. Using this data, she will create scenarios of different treatment options that will be graded in terms of appropriateness by an expert panel of surgeons, medical oncologists, gastroenterologists and other physicians. She will then review cases that have been treated in Ontario over the past 5 years. The appropriateness scores will be applied to the reviewed cases, and a determination will be made regarding the percentage of patients receiving appropriate care, areas in which inappropriate care made the largest negative impact on survival, and potential areas for knowledge translation efforts. Furthermore, Dr Coburn will synthesize the results of the expert panel into an algorithm that surgeons can use in future decision making. The results of this study will be used to produce performance measures that can be used across North America for the care of gastric cancer patients. Impact and relevance: The results of this study will be used to produce performance measures that can be used across North America for the care of gastric cancer patients. Dr Coburn will identify areas of inappropriate care that most impact survival of gastric cancer patients, so that knowledge translation efforts and organizational changes can be focused on these issues. By defining optimal care, and identifying areas of inadequate care, her hope is to improve outcomes for patients with gastric cancer. Category of Research: Intervention and program delivery/evaluation Cancer Site Relevance: Alimentary tract _