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Clinical Outcomes After Implementation of Regionalized Gastric Cancer Care in an Integrated Healthcare System
Regionalization of gastric cancer care in a US integrated healthcare system increased care specialization and standardization, improving clinical outcomes for patients (J Clin Oncol. 2021;JCO2100480. doi:10.1200/JCO.21.00480).
“In 2016, Kaiser Permanente Northern California regionalized gastric cancer care, introducing a regional comprehensive multidisciplinary care team, standardizing staging and chemotherapy, and implementing laparoscopic gastrectomy and D2 lymphadenectomy for patients eligible for curative-intent surgery,” explained Swee H. Teh, MD, The Permanente Medical Group, Gastric Surgery, Northern California, Oakland, and colleagues, who aimed to evaluate the effect of this regionalization on clinical outcomes.
The electronic medical record, cancer registry, state vital statistics, and chart review were used to gather information on gastric cancer cases diagnosed from January 2010 to May 2018.
Annual inception reports compared overall survival (OS) in patients with all stages of disease, stage I-III disease, and curative-intent gastrectomy patients. For curative-intent gastrectomy patients, the surgical approach and surgical outcomes were also compared.
A total of 1429 patients with gastric cancer were included in the study; 942 patients diagnosed before regionalization and 487 patients treated after. Overall, 650 patients had stage I-III disease and 394 underwent curative-intent surgery.
Among patients who received surgery, neoadjuvant chemotherapy utilization increased from 35% to 66% (P <.0001), laparoscopic gastrectomy increased from 18% to 92% (P <.0001), and D2 lymphadenectomy increased from 2% to 80% (P >.0001), before and after implementation, respectively. In addition, dissection of ≥15 lymph nodes increased from 61% to 95% (P <.0001).
Dr Teh and colleagues reported the length of hospitalization decreased from 7 day before regionalization to 3 days after regionalization (P <.001). OS at 2 years was 32.8% before regionalization and 37.3% after regionalization for all stages (P = .20); 55.6% and 61.1% for stage I-III cases with or without surgery (P = .25); and 72.7% and 85.5% for patients who received surgery (P >.03).
“Regionalization of gastric cancer care within an integrated system allowed comprehensive multidisciplinary care, conversion to laparoscopic gastrectomy and D2 lymphadenectomy, increased overall survival among surgery patients, and no increase in surgical complications,” concluded Dr Teh and colleagues.—Janelle Bradley
