Assessing and improving optimal cancer care pathway targets in oesophagogastric cancer at Monash Health

In Australia, more than 2,000 people are diagnosed with gastric cancer and around 1,600 with oesophageal cancer every year. Survival outcomes for oesophageal cancer are poor, with a 5-year overall survival of about 20% and 30% respectively. Improving outcomes is a multifaceted endeavour. This ranges from early intervention, optimisation of initial investigation and work-up, and improvement in timing and quality of treatment. Early referral to specialist palliative care is vital for those with non-curable disease. Expert guidelines on the optimal care pathway in oesophagogastric cancer were published in 2015 and updated in 2021. Surgical teams play a key role in the initial assessment of patients with oesophagogastric cancer. An important aspect of the optimal care pathway are the recommended timeframes to treatment, with the ultimate goal of no more than six weeks from presentation to initiation of treatment. There are many barriers to implementation of the optimal cancer care pathways and targets at the ground level. Limited resources within the public health system need to be allocated carefully to reach these targets. Ongoing assessment of timeframes and comparison with targets is essential to identify deficiencies and help to guide resource reallocation and quality improvement efforts. Furthermore, the years of COVID has increased strain on the public health waitlists, impeding proper triage and assessment of patients presenting with worrisome features. In this project, we aim to assess our timeframes to care Monash Health, the changes that occurred during COVID and the potential barriers to reaching optimal target timeframes. Specifically, we aim to: • Measure the time between referral, specialist review, MDT discussion and initiation of treatment, and compare these to the recommended standards; • Compare any differences in timeframes between the pre-COVID, COVID and post-COVID. • Identify potential areas of delay and describe potential causative factors.