Abstract
This thesis aimed to study the occurrence and treatment of oesophageal and gastric cancer patients in England between 1998 and 2009. Variation in incidence over time, by socioeconomic deprivation, and between ethnic groups for six subgroups of these cancers (upper and middle oesophagus, lower oesophagus, oesophagus not otherwise specified (NOS), cardia, non-cardia, gastric NOS) was investigated. Factors that affected who received surgery for these cancers were examined and survival in relation to hospital volume (measured as the annual number of operations per hospital) was assessed.Key findings include an increase in the incidence of lower oesophageal cancer in men, a higher incidence of this and cardia cancers in men, a higher incidence of these subgroups in White men compared with the other ethnic groups studied, a higher incidence of upper and middle oesophageal cancer in Bangladeshi women compared with White women, and in each subgroup a higher incidence in more deprived areas and a poor prognosis. The different patterns of incidence are likely to be explained by differences in exposures to risk factors. These findings confirm patterns reported in other developed countries, and highlight the importance of preventative initiatives.
Older patients and patients resident in more deprived areas were less likely to undergo surgery. This could be explained by several valid reasons, including differences in performance status, disease stage, or willingness to undergo surgery. Data on these factors were not available for analysis but should be further investigated to ensure that surgery is available to all who will benefit clinically from it. This work found lower mortality with increasing hospital volume, both in the short- and long-term. For the first time in England, this work assessed the effect of hospital volume on survival and found that the centralisation of surgical services for these patients has been beneficial. The work supports the continued centralisation of these services.
| Date of Award | 2013 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Elizabeth Davies (Supervisor), Henrik Møller (Supervisor) & Jesper Lagergren (Supervisor) |