Changes in diagnostic and treatment strategies of oesophageal cancer in the period from 2001 to 2009: A survey in the Netherlands

Background: In 2005, national guidelines on the diagnosis, staging and treatment of oesophageal cancer were published. We investigated whether staging and treatment strategies of oesophageal cancer had changed over the last decade and indeed followed these guidelines. Materials and methods: In 2001, a questionnaire investigating staging and treatment strategies for oesophageal cancer was sent to Dutch clinicians (response rate 64%). In 2009, the same questionnaire (response rate 41%) was repeated, thus enabling comparison of staging and treatment strategies for oesophageal cancer between 2001 and 2009 and comparing this with the nationwide guidelines of 2005. Results: The advice to use endoscopic ultrasound for staging was followed by the majority of clinicians [84% in 2009 compared with 58% in 2001 (P<0.001)], whereas positron emission tomography scanning was used by almost half of clinicians (44% in 2009, not asked in 2001). There was a strong support for the use of neoadjuvant chemoradiation in 2009 (68% preferred this treatment for a young patient in good condition without metastases), whereas the Dutch guidelines did not recommend routine use of neoadjuvant treatment in 2005. Stent placement for palliation of dysphagia was reduced [from 92% in 2001 to 27% in 2009 (P<0.001)] due to an increased use of other palliative measures, including brachytherapy. An increased use of chemotherapy (19%) or chemoradiation (39%) was noticed in younger patients (<55 years) with metastatic disease. Conclusion: Major changes in staging and treatment strategies were observed in patients with oesophageal cancer over the last decade. Although these changes in staging strategies were in concordance to the guidelines introduced in 2005, treatment strategies with curative intent were more often diverse in 2009 and not following guidelines. This suggests that in a rapidly evolving field as oncology, guideline recommendations on treatment should be updated frequently to reflect state-of-the-art knowledge with implementation of results of clinical studies.

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