Skip to main content
Top

Open Access 25-04-2024 | Esophageal Cancer | RESEARCH ARTICLE

How appropriate is treating patients diagnosed with advanced esophageal cancer with anticancer drugs? A multicenter retrospective cohort Spanish study

Authors: Marilina Santero, Carolina Requeijo, Maria Jesus Quintana, Dulce Rodríguez, David Bottaro, Ismael Macias, Carles Pericay, Natalie Farina, Jesus Manuel Blanco, Iratxe Urreta-Barallobre, Laura Punti, Maria Angeles Nava, Xavier Bonfill Cosp

Published in: Clinical and Translational Oncology

Login to get access

Abstract

Aim

To assess the appropriateness of systemic oncological treatments (SOT) provided to patients diagnosed with advanced esophageal cancer (EC) across a group of participating hospitals.

Methods

Multicenter, retrospective cohort study in five Spanish hospitals including newly confirmed advanced EC cases between July 1, 2014, and June 30, 2016, with a 5-year follow-up.

Results

We identified 157 patients fulfilling the inclusion criteria (median age: 65 years, 85.9% males). Most patients, 125 (79.6%) were treated at least with one active treatment, and 33% received two or more lines of SOT. The 1-, 2- and 5-year overall survival rates were 30.3% [95%CI: 23.8, 38.7], 14.0% [95%CI: 9.3, 21.0], and 7.1% [95% CI: 3.8, 13.1] respectively, and the median survival time 8 months (95% CI: 6, 19) for stages IIIb IIIc and 7 months (95% CI: 5, 9) for stage IV. Clinical stage, receiving more than one line of SOT, and treatment with radiotherapy accelerated the time to death (0.4, 0.9-, and 0.8-times shorter survival respectively, p < 0.05). Better performance status (ECOG < 2) extended survival time by 2.2 times (p = 0.04). Age < 65 years (OR 9.4, 95% CI 3.2, 31.4, p < 0.001), and being treated in one particular hospital (OR 0.2, 95% CI 0.0, 0.8, p < 0.01) were associated with the administration of two or more lines of SOT. Altogether, 18.9% and 9.0% of patients received chemotherapy in the last four and two weeks of life, respectively. Moreover, 2.5% of patients were prescribed a new line of chemotherapy during the last month of life. The proportion of all patients who did not have access to palliative care reached 29.3%, and among those who had access to it, 34.2% initiated it in the last month of life.

Conclusion

A high proportion of advanced EC patients receive many treatments not based on sound evidence and they do not benefit enough from palliative care services. The most accepted appropriateness indicators point out that some of the analyzed patients could have been overtreated. This study provides important insights into the quality of care provided to advanced EC, and furthermore, for giving valuable insight and opportunities for improvement.
Appendix
Available only for authorised users
Literature
1.
go back to reference Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 209–49. https://doi.org/10.3322/caac.21660. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 209–49. https://​doi.​org/​10.​3322/​caac.​21660.
2.
go back to reference Morgan E, Soerjomataram I, Rumgay H, Coleman HG, Thrift AP, Vignat J, et al. The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040: new estimates from GLOBOCAN 2020. Gastroenterology. 2022;163:649-658.e2.CrossRefPubMed Morgan E, Soerjomataram I, Rumgay H, Coleman HG, Thrift AP, Vignat J, et al. The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040: new estimates from GLOBOCAN 2020. Gastroenterology. 2022;163:649-658.e2.CrossRefPubMed
5.
go back to reference Launoy G, Bossard N, Castro C, Manfredi S, the GRELL EUROCARE-5 Working Group. Trends in net survival from esophageal cancer in six European Latin countries: results from the SUDCAN population-based study. Eur J Cancer Prev. 2017;26: S24. Launoy G, Bossard N, Castro C, Manfredi S, the GRELL EUROCARE-5 Working Group. Trends in net survival from esophageal cancer in six European Latin countries: results from the SUDCAN population-based study. Eur J Cancer Prev. 2017;26: S24.
6.
go back to reference Arnold M, Morgan E, Bardot A, Rutherford MJ, Ferlay J, Little A, et al. International variation in oesophageal and gastric cancer survival 2012–2014: differences by histological subtype and stage at diagnosis (an ICBP SURVMARK-2 population-based study). Gut. 2022;71:1532–43.PubMed Arnold M, Morgan E, Bardot A, Rutherford MJ, Ferlay J, Little A, et al. International variation in oesophageal and gastric cancer survival 2012–2014: differences by histological subtype and stage at diagnosis (an ICBP SURVMARK-2 population-based study). Gut. 2022;71:1532–43.PubMed
7.
go back to reference Bleiberg H, Conroy T, Paillot B, Lacave AJ, Blijham G, Jacob JH, et al. Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer. Eur J Cancer. 1997;33:1216–20.CrossRefPubMed Bleiberg H, Conroy T, Paillot B, Lacave AJ, Blijham G, Jacob JH, et al. Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer. Eur J Cancer. 1997;33:1216–20.CrossRefPubMed
8.
go back to reference Liu Y, Ren Z, Yuan L, Xu S, Yao Z, Qiao L, et al. Paclitaxel plus cisplatin vs. 5-fluorouracil plus cisplatin as first-line treatment for patients with advanced squamous cell esophageal cancer. Am J Cancer Res. 2016;6:2345–50.PubMedPubMedCentral Liu Y, Ren Z, Yuan L, Xu S, Yao Z, Qiao L, et al. Paclitaxel plus cisplatin vs. 5-fluorouracil plus cisplatin as first-line treatment for patients with advanced squamous cell esophageal cancer. Am J Cancer Res. 2016;6:2345–50.PubMedPubMedCentral
11.
12.
15.
go back to reference Tramontano AC, Nipp R, Kong CY, Yerramilli D, Gainor JF, Hur C. Hospice use and end-of-life care among older patients with esophageal cancer. Health Sci Rep. 2018;1: e76.CrossRefPubMedPubMedCentral Tramontano AC, Nipp R, Kong CY, Yerramilli D, Gainor JF, Hur C. Hospice use and end-of-life care among older patients with esophageal cancer. Health Sci Rep. 2018;1: e76.CrossRefPubMedPubMedCentral
16.
go back to reference Prigerson HG, Bao Y, Shah MA, Paulk ME, LeBlanc TW, Schneider BJ, et al. Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol. 2015;1:778–84.CrossRefPubMedPubMedCentral Prigerson HG, Bao Y, Shah MA, Paulk ME, LeBlanc TW, Schneider BJ, et al. Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol. 2015;1:778–84.CrossRefPubMedPubMedCentral
17.
go back to reference Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Orthod. 2017;35:96–112. Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Orthod. 2017;35:96–112.
18.
go back to reference Kao S, Shafiq J, Vardy J, Adams D. Use of chemotherapy at end of life in oncology patients. Ann Oncol. 2009;20:1555–9.CrossRefPubMed Kao S, Shafiq J, Vardy J, Adams D. Use of chemotherapy at end of life in oncology patients. Ann Oncol. 2009;20:1555–9.CrossRefPubMed
19.
go back to reference Urvay S, Civelek B, Özaslan E, Sürel AA. Chemotherapy at the end of life. J Palliat Care. 2021;36:73–7.CrossRefPubMed Urvay S, Civelek B, Özaslan E, Sürel AA. Chemotherapy at the end of life. J Palliat Care. 2021;36:73–7.CrossRefPubMed
22.
go back to reference Al Mouaalamy N, Al Marwani K, Al Mehmadi A, Al Nakhli AA, Al Ghamdi Y, Zarkan A, et al. Referral time of advance cancer patients to palliative care services and its predictors in specialized cancer center. Cureus. 2020;12:e12300. Al Mouaalamy N, Al Marwani K, Al Mehmadi A, Al Nakhli AA, Al Ghamdi Y, Zarkan A, et al. Referral time of advance cancer patients to palliative care services and its predictors in specialized cancer center. Cureus. 2020;12:e12300.
23.
go back to reference Woldie I, Elfiki T, Kulkarni S, Springer C, McArthur E, Freeman N. Chemotherapy during the last 30 days of life and the role of palliative care referral, a single center experience. BMC Palliat Care. 2022;21:20.CrossRefPubMedPubMedCentral Woldie I, Elfiki T, Kulkarni S, Springer C, McArthur E, Freeman N. Chemotherapy during the last 30 days of life and the role of palliative care referral, a single center experience. BMC Palliat Care. 2022;21:20.CrossRefPubMedPubMedCentral
25.
go back to reference Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ, Block S. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol. 2003;21:1133–8.CrossRefPubMed Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ, Block S. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol. 2003;21:1133–8.CrossRefPubMed
26.
go back to reference Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ. Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol. 2008;26:3860–6.CrossRefPubMedPubMedCentral Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ. Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol. 2008;26:3860–6.CrossRefPubMedPubMedCentral
27.
go back to reference Santero M, Pérez-Bracchiglione J, Acosta-Dighero R, Meade AG, Antequera A, Auladell-Rispau A, et al. Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews. BMC Cancer. 2021;21:712.CrossRefPubMedPubMedCentral Santero M, Pérez-Bracchiglione J, Acosta-Dighero R, Meade AG, Antequera A, Auladell-Rispau A, et al. Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews. BMC Cancer. 2021;21:712.CrossRefPubMedPubMedCentral
28.
go back to reference Pérez-Bracchiglione J, Salazar J, Santero M, Requeijo C, Grijalva GR, Acosta-Dighero R, et al. Efficacy of systemic oncological treatments in patients with advanced, non-intestinal digestive cancer at high risk of dying in the middle and short term: evidence synthesis (ASTAC-study). Open Sci Framework. 2022. https://doi.org/10.17605/OSF.IO/7CHX6 Pérez-Bracchiglione J, Salazar J, Santero M, Requeijo C, Grijalva GR, Acosta-Dighero R, et al. Efficacy of systemic oncological treatments in patients with advanced, non-intestinal digestive cancer at high risk of dying in the middle and short term: evidence synthesis (ASTAC-study). Open Sci Framework. 2022. https://​doi.​org/​10.​17605/​OSF.​IO/​7CHX6
29.
go back to reference Salazar J, Pérez-Bracchiglione J, Salas-Gama K, Antequera A, Auladell-Rispau A, Dorantes-Romandía R, et al. Efficacy of systemic oncological treatments in patients with advanced pancreatic cancer at high risk of dying in the short or medium-term: overview of systematic reviews. Eur J Cancer. 2021;154:82–91.CrossRefPubMed Salazar J, Pérez-Bracchiglione J, Salas-Gama K, Antequera A, Auladell-Rispau A, Dorantes-Romandía R, et al. Efficacy of systemic oncological treatments in patients with advanced pancreatic cancer at high risk of dying in the short or medium-term: overview of systematic reviews. Eur J Cancer. 2021;154:82–91.CrossRefPubMed
31.
go back to reference Salazar J, Bracchiglione J, Acosta-Dighero R, Meza N, Meade A-G, Quintana MJ, et al. Systemic oncological treatments in patients with advanced pancreatic cancer: a scoping review and evidence map. Supp Care Cancer. 2023;31:100.CrossRef Salazar J, Bracchiglione J, Acosta-Dighero R, Meza N, Meade A-G, Quintana MJ, et al. Systemic oncological treatments in patients with advanced pancreatic cancer: a scoping review and evidence map. Supp Care Cancer. 2023;31:100.CrossRef
33.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573–7.CrossRef von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573–7.CrossRef
35.
go back to reference Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.CrossRef Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.CrossRef
36.
go back to reference RStudio. RStudio: integrated development for R. Rstudio Team. Boston: PBC. RStudio. RStudio: integrated development for R. Rstudio Team. Boston: PBC.
38.
go back to reference Fernández-Montes A, Alcaide J, Alsina M, Custodio AB, Franco LF, Gallego Plazas J, et al. SEOM-GEMCAD-TTD Clinical Guideline for the diagnosis and treatment of esophageal cancer (2021). Clin Transl Oncol. 2022;24:658–69.CrossRefPubMedPubMedCentral Fernández-Montes A, Alcaide J, Alsina M, Custodio AB, Franco LF, Gallego Plazas J, et al. SEOM-GEMCAD-TTD Clinical Guideline for the diagnosis and treatment of esophageal cancer (2021). Clin Transl Oncol. 2022;24:658–69.CrossRefPubMedPubMedCentral
40.
go back to reference National Guideline Alliance (UK). Oesophago-gastric cancer: Assessment and management in adults. London: National Institute for Health and Care Excellence (NICE); National Guideline Alliance (UK). Oesophago-gastric cancer: Assessment and management in adults. London: National Institute for Health and Care Excellence (NICE);
41.
go back to reference Schleicher SM, Bach PB, Matsoukas K, Korenstein D. Medication overuse in oncology: current trends and future implications for patients and society. Lancet Oncol. 2018;19:e200–8.CrossRefPubMedPubMedCentral Schleicher SM, Bach PB, Matsoukas K, Korenstein D. Medication overuse in oncology: current trends and future implications for patients and society. Lancet Oncol. 2018;19:e200–8.CrossRefPubMedPubMedCentral
43.
go back to reference Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733–42.CrossRefPubMed Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733–42.CrossRefPubMed
44.
go back to reference Lu Z, Fang Y, Liu C, Zhang X, Xin X, He Y, et al. Early interdisciplinary supportive care in patients with previously untreated metastatic esophagogastric cancer: a phase III randomized controlled trial. J Clin Oncol. 2021;39:748–56.CrossRefPubMedPubMedCentral Lu Z, Fang Y, Liu C, Zhang X, Xin X, He Y, et al. Early interdisciplinary supportive care in patients with previously untreated metastatic esophagogastric cancer: a phase III randomized controlled trial. J Clin Oncol. 2021;39:748–56.CrossRefPubMedPubMedCentral
45.
go back to reference Parikh RB, Kirch RA, Smith TJ, Temel JS. Early specialty palliative care–translating data in oncology into practice. N Engl J Med. 2013;369:2347–51.CrossRefPubMedPubMedCentral Parikh RB, Kirch RA, Smith TJ, Temel JS. Early specialty palliative care–translating data in oncology into practice. N Engl J Med. 2013;369:2347–51.CrossRefPubMedPubMedCentral
46.
go back to reference Saito AM, Landrum MB, Neville BA, Ayanian JZ, Earle CC. The effect on survival of continuing chemotherapy to near death. BMC Palliat Care. 2011;10:1–11.CrossRef Saito AM, Landrum MB, Neville BA, Ayanian JZ, Earle CC. The effect on survival of continuing chemotherapy to near death. BMC Palliat Care. 2011;10:1–11.CrossRef
47.
go back to reference Suissa S. Immortal time bias in observational studies of drug effects. Pharmacoepidemiol Drug Saf. 2007;16:241–9.CrossRefPubMed Suissa S. Immortal time bias in observational studies of drug effects. Pharmacoepidemiol Drug Saf. 2007;16:241–9.CrossRefPubMed
49.
go back to reference Ostgathe C, Voltz R. Quality indicators in end-of-life care. Curr Opin Support Palliat Care. 2010;4:170–3.CrossRefPubMed Ostgathe C, Voltz R. Quality indicators in end-of-life care. Curr Opin Support Palliat Care. 2010;4:170–3.CrossRefPubMed
50.
go back to reference Szigethy E, Dorantes R, Sugrañes M, Madera M, Sola I, Urrútia G, et al. Frequency of anticancer drug use at the end of life: a scoping review. Clin Transl Oncol. 2023;4:1–12. Szigethy E, Dorantes R, Sugrañes M, Madera M, Sola I, Urrútia G, et al. Frequency of anticancer drug use at the end of life: a scoping review. Clin Transl Oncol. 2023;4:1–12.
Metadata
Title
How appropriate is treating patients diagnosed with advanced esophageal cancer with anticancer drugs? A multicenter retrospective cohort Spanish study
Authors
Marilina Santero
Carolina Requeijo
Maria Jesus Quintana
Dulce Rodríguez
David Bottaro
Ismael Macias
Carles Pericay
Natalie Farina
Jesus Manuel Blanco
Iratxe Urreta-Barallobre
Laura Punti
Maria Angeles Nava
Xavier Bonfill Cosp
Publication date
25-04-2024
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-024-03436-1
Live Webinar | 01-10-2024 | 12:30 (CEST)

Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

Live: Tuesday 1st October 2024, 12:30-14:00 (CEST)

In this live webinar, Professor Martin Dreyling and an esteemed, international panel of CAR-T experts will discuss the very latest data on the safety, efficacy and clinical impact of CAR T-cell therapies in the treatment of r/r DLBCL and r/r FL, as presented at ASH 2023, EU CAR-T 2024, and EHA 2024. 

Please note, this webinar is not intended for healthcare professionals based in the US and UK.

Sponsored by: Novartis Pharma AG

Chaired by: Prof. Martin Dreyling
Developed by: Springer Healthcare