Oesophageal and Gastric Cancer: optimising care and outcomes in changing clinical practice

Improving quality of care for patients with oesophageal and gastric cancer is a major challenge as the incidence is relatively low and most patients have an advanced disease at time of diagnosis. The studies presented in this thesis aimed to give more insight in the provided care and outcomes for patients with oesophageal and gastric cancer in daily clinical practice. It was shown that the hospital of diagnosis influences the probability to receive curative treatment for oesophageal and gastric cancer. Moreover, its impact on survival indicates that treatment decision-making may be improved for patients with these malignancies. It was also shown that survival improved for patients with oesophageal cancer the last 26 years, probably due to the introduction of neoadjuvant chemoradiotherapy and centralisation of surgery. Survival of patients with gastric cancer improved as well in the period after centralisation of surgery. Nevertheless, many gastric cancer patients that are eligible for perioperative treatment do not receive the adjuvant component of perioperative treatment or they do not receive chemotherapy at all in addition to surgery. Furthermore, survival remained stable for patients with metastatic gastric cancer, despite an increase in the use of palliative chemotherapy. To conclude, the studies in this thesis addressed several important challenges in diagnosis and treatment of oesophageal and gastric cancer.

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