Gastric cancer: patient and treatment characteristics in relation to outcome

In this thesis we investigated factors influencing outcome of gastric cancer and consequences on quality of care.
Survival of gastric cancer patients in hospitals in North East Netherlands is independent of operation volume. The percentage octo- and nonagenarians that die after gastric surgery is too high compared to younger patients. Also most patients still present with an advanced stage of disease in which prolonging survival with preservation of quality of life is important. An outpatient regimen of oxaliplatin, leucovorin, uracil/tegafur seems to have an efficacy comparable to more customary used medicine, with less hand foot toxicity. Long term survivors are positive exceptions. However a case report showed that doctors need to realize that it is not only difficult to deal with unexpected bad news but also with unexpected good news, such as long term survival.
To improve outcome of the Dutch health care, research at influenceable factors is important. In this thesis we report that gastric cancer patients with a high social economic status have a better survival compared to low social economic status. Also survival of first generation non-western immigrants with gastric cancer was not worse than that of western immigrants or natives.
Research on prevention showed that all carriers of abnormalities in the CDH1 gene should be advised to undergo a stomach resection because of the high chance of developing gastric cancer and female carriers also a breast resection to prevent breast cancer. Abnormalities in the CDH1 gene also seem to be associated with development of cleft lip/palate disturbances.

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