Evaluation of variation in oesophagus and gastric cancer care and the impact of supra-regional multidisciplinary team meetings in the Managed Clinical Network in the Northeast of the Netherlands.

Introduction: Prior studies describe a large variation in oesophageal and gastric cancer care. Over the past few years, many oncology networks have been established to ensure the quality, accessibility and affordability of cancer care regardless of the hospital of diagnosis. This study aimed to evaluate variation in treatment and survival among hospitals within the Managed Clinical Network (MCN) oesophagogastric cancer in the northeast region of the Netherlands in recent years. Moreover, the impact of a pilot of supra-regional multidisciplinary team (SMDT) meetings was examined. Methods: Patients with oesophageal or gastric cancer diagnosed from 2016 until 2021 were selected from the Netherlands Cancer Registry (NCR). Differences in treatment strategies and lead times to the start of treatment between hospital clusters and individual hospitals were analysed and compared to a national benchmark. In addition, differences in referrals to hospitals outside the MCN and survival were analysed among the clusters. Data of patients discussed at the SMDT meetings were selected from the medical records of the Top Clinical Hospital Group Twente. Outcomes of patients discussed at the SMDT meetings were compared to a matched control group of patients treated in the MCN selected from the NCR. Moreover, deviations between the treatment advice of the SMDT meeting, the treatment advice of the regional MDT meeting and the received treatment were analysed. Results: A total of 4206 patients, receiving treatment within the MCN, were included. Potentially curable patients diagnosed in the MCN in 2020-2021 equally received treatment with curative intent, regardless of the hospital cluster (range: 69-73%, p=0.342). The odds ratios on the probability of receiving treatment with curative intent ranged between 0.87 (p=0.693) and 1.96 (p=0.026) per hospital of diagnosis. The median lead time from diagnosis to the start of treatment with curative intent varied significantly among the clusters (range: 38-49 days, p<0.001) and individual hospitals (OR 0.38, p<0.001 and OR 2.72, p<0.001). The survival of patients did not vary among the clusters. Patients discussed at the SMDT meetings had no delay in the lead time to the start of treatment compared to a matched control group (p=0.3466). For about half of the patients, the treatment advice of the SMDT meeting deviated from the advice of the regional MDT meeting. The treatment recommended at the SMDT meeting was received by the majority of patients. Conclusion: This study demonstrated that oncology networks can contribute to uniformity in treatment decisions and equal survival among hospitals. Differences in lead time to treatment appear to remain. The SMDT meetings can contribute to uniformity in treatment decisions for complex cases, without impacting the lead time to the start of treatment.