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Background: Patients living in rural communities experience difficulty accessing specialized medical care. Rural patients with cancer present with more advanced disease, have reduced access to treatment and have poorer overall survival than urban patients. This study's aim was to evaluate outcomes of patients with gastric cancer living in rural and remote areas versus urban and suburban communities in the context of an established care corridor to a tertiary care centre. Methods: All patients treated for gastric cancer at the McGill University Health Centre during 2010-2018 were included. Travel, lodging and cancer care coordination were provided for patients from remote and rural areas and coordinated centrally by dedicated nurse navigators servicing these regions. Statistics Canada's remoteness index was used to categorize patients into a rural and remote group and an urban and suburban group. Results: A total of 274 patients were included. Compared with patients from urban and suburban areas, patients from rural and remote areas were younger and their clinical tumour stage was higher at presentation. The number of curative resections and palliative surgeries and rate of nonresection were comparable (p = 0.96). Overall, disease-free and progression-free survival were comparable between the groups, and having locally advanced cancer correlated with poorer survival (p < 0.001). Conclusion: Although patients with gastric cancer from rural and remote areas had more advanced disease at presentation, their treatment patterns and survival were comparable to those of patients from urbanized areas in the context of a publicly funded care corridor to a multidisciplinary specialist cancer centre. Equitable access to health care is necessary to diminish any preexisting disparities among patients with gastric cancer. Contexte: Les malades des communautés rurales ont de la difficulté à accéder à des soins médicaux spécialisés. Les personnes cancéreuses des milieux ruraux ont une maladie plus avancée, un accès moindre au traitement et une moins bonne survie globale comparativement aux malades des milieux urbains. Cette étude avait pour but de comparer les résultats chez les malades aux prises avec un cancer de l'estomac qui vivent en région rurale ou éloignée et chez ceux qui vivent en ville ou en banlieue dans le contexte d'un corridor de services dument affilié à un centre de soins tertiaires. Méthodes : Nous avons inclus tous les malades traités pour un cancer de l'estomac au Centre universitaire de santé McGill de 2010 à 2018. Les déplacements, l'hébergement et la coordination des traitements oncologiques étaient fournis aux patients de régions rurales et éloignées, sous la coordination centrale d'un personnel infirmier pivot attitré desservant ces régions. L'indice d'éloignement de Statistique Canada a servi à catégoriser les malades selon qu'ils appartenaient à un groupe de région rurale et éloignée ou à un groupe de région urbanisée. Résultats: En tout, 274 patients ont été inclus. Comparativement aux malades de la ville ou de la banlieue, les malades des régions rurales et éloignées étaient plus jeunes, et le stade clinique de leur tumeur était plus élevé au moment de consulter. Le nombre de résections à visée curative, de chirurgies palliatives et le taux de non-résection étaient comparables (p = 0,96). Globalement les groupes ont enregistré des taux comparables de survie sans maladie et de survie sans progression, et les cancers localement avancés étaient en corrélation avec une moins bonne survie (p < 0,001). Conclusion: Même si les malades aux prises avec un cancer de l'estomac provenant de régions rurales et éloignées avaient une maladie plus avancée au moment de consulter, leurs modalités thérapeutiques et leur survie ont été comparables à celles des malades de régions urbanisés dans le contexte d'un corridor de services financés à même les fonds publics donnant accès à un centre d'oncologie multidisciplinaire. Un accès équitable aux soins de santé est nécessaire pour réduire les disparités existantes entre les malades atteints d'un cancer de l'estomac., Approximately 20% of North Americans (70 million people) live in rural communities. (1-3) Among patients with cancer, residence in a rural area has been correlated with more advanced disease stage [...]

Background: The safety and efficacy of enhanced recovery after surgery (ERAS) following elective gastrectomy for gastric cancer in patients >80 years of age are not well described. The aim of this study was to explore whether an ERAS protocol following gastrectomy in this age group can be safely implemented and reduce postoperative length of stay. Methods: A retrospective, single-center analysis was performed. All patients >80 years of age with gastric cancer undergoing elective subtotal and total gastrectomy between January 2010 and December 2021 were identified. With the implementation of an ERAS protocol in January 2016, patients treated beforehand were allocated to Group A (pre-ERAS) and Group B (ERAS). The length of stay, incidence of postoperative complications and representation/readmission to the hospital were compared between the groups. Results: Of the 221 patients identified, 56 met the inclusion criteria with 22 patients (39.3%) allocated to Group A and 34 patients (60.7%) to Group B. There were no differences with regard to the type of resection and surgical approach. Length of stay was shorter in Group B (5 days, range 2–27 versus 10 days, 3–109, P =.040). A trend toward more discharges by postoperative day 3 was noted among patients in Group B (7/34, 20.6% versus 2/22, 9.1%, P =.253). There were no differences in the incidence of postoperative complications or readmission hospital between the groups. Conclusion: Among patients >80 years of age, ERAS following gastrectomy for cancer is associated with a reduced length of stay and can be safely implemented. [ABSTRACT FROM AUTHOR]

Background: Changing adherence over time to enhanced recovery after surgery (ERAS) protocols following radical gastrectomy and the impact this has on length of stay (LoS) is not well described. This study aimed to explore the changes in adherence to core ERAS elements over time and the relationship between compliance and LoS. Methods: A retrospective, single center cohort study was performed between 01/2016–12/2021. An ad hoc analysis revealed the point at which a significant difference in the number of patients being discharge on postoperative day (PoD) 3 was noted allowing allocation of patients to Group A (01/2016–12/2019) or B (01/2020–12/2021). Compliance with core ERAS elements was compared and the relationship between compliance and discharge by (PoD) 3 assessed. Variables significant on univariate analysis were assessed using binary multivariate regression. Results: Of the 268 patients identified, 187 met the inclusion criteria (Group A 112 and Group B 75). More patients in Group B mobilized on PoD 1 (60.0 vs. 31.3%, p = <0.001), tolerated postgastrectomy diet by PoD 3 (84.6 vs. 62.5%, p = 0.049), and were discharged by PoD 3 (34.7 vs. 20.5%, p = 0.002). Protocol compliance of >75% was associated with discharge on PoD 3 (area under the curve, 0.726). Active mobilization on PoD 1 (OR 3.5, p = 0.009), compliance ≥75% (OR 3.3, p = 0.036), and preoperative nutritional consult (OR 0.2, p = 0.002) were independently associated with discharge on PoD 3. Discharge on PoD 3 did not increase readmission or representation to hospital. Conclusion: Early mobilization, protocol compliance >75%, and preoperative nutritional consult were associated with discharge on PoD 3 after radical gastrectomy. [ABSTRACT FROM AUTHOR]