A case study of survival and presentation of gastroesophageal cancer in local neighbourhoods

This thesis presents a quantitative case study on incidence, survival and presentation of patients diagnosed with gastroesophageal cancer to evaluate whether where people live affects how they present and survive with a gastroesophageal cancer diagnosis. The focus research evolved from studies on gastroesophageal cancer’s ‘geographic affiliation’ and a desire to review whether patient and population attributes could be harnessed to reveal potential ‘hotspots’ to inform targeted health intervention strategies. As the most crucial stage for intervention was associated with patients detecting symptoms early enough for intervention, the focus of this case study was narrowed to survival and presentation. This research analysed data from 2785 patients who presented to a regional referral specialist cancer treatment centre between the years 2000 and 2013. Cohort analysis revealed common attributes and survival, and data were merged with demographic information in a geographic information system to present findings in mapped format. Descriptive analysis revealed an association between later stage presentation and reduced survival outcome. Emergency presentations tended to have worse outcomes. Survival deteriorated with advancing age. Gastroesophageal cancer diagnoses in the under 54 age group was more common in lower socioeconomic groups and survival outcomes were marginally lower than in those patients from the least deprived areas. Spatial analysis revealed variation in incidence, presentation and survival across the region. Though this case study revealed several new findings on gastroesophageal cancer presentation and survival, there remains no single solution to informing and encouraging earlier diagnosis interventions. Though presenting data at finer scales of resolution is more clinically relevant, it threatens patient confidentiality.