Dott. Alberto Vannelli GASTRIC CANCER AND SIMULTANEOUS CARE: PRELIMINARY REPORT ABOUT THE TAKE CHARGE APPROACH. UOS Chirurgia Oncologica, Valduce - Como

GASTRIC CANCER: WHAT’S OUR COMMITMENT?

Surgery is considered the main curative treatment for gastric cancer; Main topic of National Health Service is gastric cancer treatments’ costs; loss of productivity the cost is 134% higher than average cancer costs. In multimodal therapy era: In Italy, the cost due to care, results in:

“National Cancer Plan” intends to: reduce migration of the health care; better utilize the available resources National Health Service reduce loss of productivity

COMO 2013 migration index: 30,5%

preliminary results of the first italian simultaneous care model oncology & territory treatment costs

Como has people Incidence, highest in North Italy:18,7 vs 17,1 An average of 110 patients/year undergo surgery Migration value 30%-35%

Hospital volume gastrectomy: < 5 very low; 5-8 low; 9-13 medium; high; > 21 very high

Dikken JL Effect of hospital volume on post operative mortality and survival after oesophageal and gastric cancer surgery in the Netherlands between 1989 and Eur J Cancer May;48(7): Gastrectomies were mainly performed in low volumes, and outcomes after gastrectomy improved to a lesser extent, indicating an urgent need for improvement in quality of surgery and perioperative care for gastric cancer in the Netherlands.

Coupland VH Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, Gut Jul;62(7): With evidence of lower short-term and longer- term mortality for patients resected in high- volume hospitals, this study supports further centralisation of oesophageal and gastric cancer surgical services in England.

Ichikawa D Effect of hospital volume on long-term outcomes of laparoscopic gastrectomy for clinical stage I gastric cancer. Anticancer Res Nov;33(11): These results indicate no clinical impact of hospital volume on prognosis of patients who underwent laparoscopic gastrectomy for clinical stage I gastric cancer when performed by surgeons with sufficient experience in open gastrectomy.

Zhang WH Outcomes of surgical treatment for gastric cancer patients: 11-year experience of a Chinese high- volume hospital. Med Oncol 2014 Sep;31(9):150. To improve the survival outcomes, further efforts toward early detection and multi- disciplinary treatment are needed.

Gemmill EH Systematic review of enhanced recovery after gastro-oesophageal cancer surgery. Ann R Coll Surg Engl Apr;97(3): The evidence for enhanced recovery schemes following gastric and oesophageal resection is weak, with only three (low volume) published randomised controlled trials. However, the enhanced recovery approach appears safe and may be associated with a reduction in length of stay.

Erone onlus (oncological volunteer association) has organized a plan of simultaneous care model

How?

February 2014, in collaboration with Valduce (religious hospital), organized a two-days conference on “Oncology and territory”. The first day dedicated for everybody while the second day for general practitioners.

After one year, we examined and compared the results with the historic database of Como Local Health Authority

Following our event in 2014, that had an attendance of over 600 people, the migration index decreased to 24,5%; A cutback of migration of health care means a better use of the available resources.

Compared to 2013, gastroscopy increased of 4% (up 27% in surgery endoscopy); a sign that general practitioners paid more importance to upper gastrointestinal symptoms of their patients

Moreover in 2015, Valduce described an integrated multidisciplinary clinical protocol, on treatment of gastric cancer

As the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death, gastric cancer is a major clinical and financial burden with significant differences in territorial distribution.

Multimodal progress is extremely costly and the results often end in marginal survival benefit, therefore, excellence in surgery should be achieved.

A new program for a simultaneous care model is one of several changes required to improve the intended actions of gastric cancer surgical treatment; Our preliminary results on this model, demonstrate an advantage in territory, reducing the migration index