Optimal timeframes & summary
Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Oesophagogastric Cancer Working Group. The pathway from presentation to treatment should take no more than six weeks. Different stages of the pathway may overlap according to local practice.
Timeframes for care
|
Step in pathway |
Care point |
Timeframe |
|
Presentation, initial investigations and referral |
Signs and symptoms |
Patients with concerning (red flag) symptoms should be seen by their GP within 2 weeks |
|
Initial investigations initiated by GP |
An endoscopy should be completed within 2 weeks of GP referral |
|
|
Referral to specialist |
Where there is a confirmed diagnosis or high level of suspicion, patients should see an upper GI surgeon within 2 weeks of GP referral. Imaging/work-up as directed by the specialist can precede initial assessment but should not delay referral |
|
|
Diagnosis, staging and treatment planning |
Diagnosis and staging |
Staging work-up needs to be complete for presentation at an MDM within 2 weeks of diagnosis and within 4 weeks of GP referral |
|
Multidisciplinary meeting and treatment planning |
Patients should be discussed at an MDM within 4 weeks of GP referral |
|
|
Treatment |
Surgery |
Treatment should begin within 2 weeks of the MDM |
|
Radiation therapy |
||
|
Systemic therapy |
Seven steps of the optimal care pathway
Step 1: Prevention and early detection
Step 2: Presentation, initial investigations and referral
Step 3: Diagnosis, staging and treatment planning
Step 4: Treatment
Step 5: Care after initial treatment and recovery
Step 6: Managing recurrent, residual or metastatic disease
Step 7: End-of-life care
This pathway covers oesophagogastric cancer (oesophageal adenocarcinoma, oesophageal squamous cell carcinoma [SCC] and gastric malignancies). In Australia, more than 2,000 people are diagnosed with gastric cancer and around 1,600 with oesophageal cancer every year (AIHW 2017a).
Survival outcomes for oesophageal cancer are poor when compared with other types of cancer, with only 20 per cent of people diagnosed surviving their cancer for five years (AIHW 2017a). About two-thirds of patients with oesophageal cancer have inoperable disease at the time of diagnosis. Survival outcomes for gastric cancer are also relatively poor compared with other cancers, with only 30 per cent of patients surviving five years after diagnosis (Cancer Council Australia 2019a).
Even if there are good initial treatment outcomes, the recurrence rate is very high. Given the poor prognosis of this cancer at present, for most patients, treatment is often given with palliative rather than curative intent. Early specialist palliative care will be required for patients with oesophagogastric cancer.
