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Gastroscopy referral rates associated with esophogastric cancer outcomes
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Gastroscopy referral rates in general medical practices were linked to variations in esophagogastric cancer outcomes, with patients with the lowest referral rates at greater risk for poorer outcomes, according to recent study data.
The retrospective observational study compared information on gastroscopy in the UK’s Hospital Episode Statistics (HES) dataset (2006–2008) with death certificate records. The researchers identified 22,488 incident cases of esophagogastric (EG) cancer from 6,513 general practices.
Researchers wrote that current British practice guidelines restrict referral for gastroscopy to dyspepsia patients with “alarm symptoms” that may signify advanced disease and thus affect EG cancer outcomes. Those symptoms, they said, were not developed specifically as possible cancer indicators.
The study also found wide variations in gastroscopy rates among general practices, suggesting differing guideline interpretations. Older adults in socioeconomically disadvantaged regions were the least likely to be referred for gastroscopy. Those patients also had disproportionately poorer EG cancer outcomes.
When adjusted for patient age, gender, comorbidity, poverty and socioeconomic status, practices in the lowest tertile for gastroscopy referral had the lowest patient rate of major surgery (aOR=0.87; 95% CI, 0.79-0.95), highest rate of emergency admission (aOR=1.73; 95% CI, 1.6-1.88) and highest mortality (aOR=1.14; 95% CI, 1.06-1.22 within 12 months of gastroscopy) among EG cancer patients.
The researchers suggested that British gastroscopy guidelines be revised and that primary care practices with low gastroscopy referral rates undertake targeted efforts to ensure that at-risk patients for EG cancer — specifically, socioeconomically disadvantaged older adults — undergo the procedure.
“These findings suggest that initiatives or current guidelines aimed at limiting the use of gastroscopy may adversely affect cancer outcomes,” the researchers concluded. “If the situation is to improve, current referral guidelines and strategies to support compliance require urgent attention.”
Disclosure: The researchers report no relevant financial disclosures.
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