Daily clinical practice and patterns of care in upper gastrointestinal cancer treatment Toxicity, quality of life and survival

Upper gastrointestinal (GI) cancers - esophageal, gastric and pancreatic cancer - have a dismal prognosis. Despite treatment with curative intent, randomized clinical trials report 5-year survival rates of only 47% in esophageal cancer, 36 % in gastric cancer and 21% in pancreatic cancer. In population-based series 5-year survival rates of patients treated with curative intent are even lower and range from in 19-25% in esophageal cancer, 20-31% in gastric cancer and 11-16% in pancreatic cancer.
Besides the poor results of treatment, management of upper GI cancers is further complicated by the occurrence of side effects of oncological treatment. This is more prominent in upper GI cancer due to the extent of upper GI surgery, with potentially severe complications, as well as the use of multimodality treatment (radiation, chemotherapy), which cannot always spare vital organs. This may severely impact quality of life and functional outcome of these patients.
The poor prognosis, the potentially severe toxicity of treatment and late presentation of the disease together with the relatively low incidence pose a great challenge to the optimization of outcomes of patients with upper GI cancer. The main aim of this thesis is to investigate toxicity and functional outcome of treatment of locally advanced esophageal cancer and to investigate treatment strategies for metastatic esophagogastric and pancreatic cancer, with a special focus on differences in management and survival between Dutch hospitals in daily practice.