Surgeon Bilal Alkhaffaf

Improving research into stomach cancer

Patients, surgeons and cancer specialist nurses across the globe have agreed on a group of key outcomes (effects of treatments) that will improve research in gastric cancer – also known as stomach cancer.

Stomach cancer is a leading cause of cancer-related death and over a million cases are diagnosed each year worldwide. Survival rates have not improved significantly over the last 50 years, and only around 15 per cent of patients in England live for more than 10 years after diagnosis. This highlights the importance of making the most of research on the issue.

Surgery is the main treatment that can offer a potential cure for stomach cancer, but this sort of major operation can result in serious complications and have an impact on patients’ quality of life for many months. Identifying the best surgical approaches should be based on comparing outcomes from well-designed research but currently, trials report different outcomes which makes it difficult to compare results.

To address this, the NIHR-funded GASTROS study brought together healthcare professionals and patients to develop a core outcome set (COS)—a standardized group of outcomes that should be reported by future trials in this field.

Mr Bilal Alkhaffaf, a Consultant Oesophago-Gastric Surgeon at Salford Royal and Honorary Senior Lecturer at The University of Manchester, is the Chief Investigator for the study.

Mr Alkhaffaf explained: “Nearly 500 outcomes were identified from previously reported trials and patient interviews. These were organised into 56 items which we asked nearly 1,000  patients, surgeons and nurses from 55 countries to prioritise. Following two rounds of surveys and a consensus meeting, eight key outcomes were agreed on that future studies in this field should measure and report. This will improve the quality of research and contribute towards finding better treatments for gastric cancer.

“A guiding principle of the GASTROS study was that patients’ voices should be represented at each stage. Patient representatives were integral to the work, which was supported by international patients groups and charities.

“It was also important that we had broad international support, with participants from 55 countries across 6 continents in both high and low-to-medium income settings.”

The eight core outcomes recommended to be used in all future research in this field to improve trial design and comparison of evidence are:

  • Disease-free survival (how long someone is alive without cancer returning.)
  • Disease-specific survival (dying from stomach cancer. This does not include dying from treatment for stomach cancer.)
  • Surgery-related death (dying as a direct consequence of surgery)
  • Recurrence (the chances of the cancer coming back)
  • Completeness of tumour removal (ensuring the tumour has been surgically removed)
  • Overall quality of life.
  • Nutritional effects (the extent to which the body can consume and use the nutrients needed to function properly)
  • Serious complications

The next steps will include making sure that researchers use the set of outcomes in their research. This will involve spreading the results in journals and in scientific meetings. There are also a number of questions that still need to be answered, such as how some of these outcomes should be measured. This will form the basis of future work that has already started.

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