Revealing the gaps: unwarranted variations and multidisciplinary solutions in Victorian oesophagogastric cancer care — A mixed-methods analysis

An unwarranted variation in cancer care and/or outcome is a disparity that is not explained by differences in patient illness or preferences. The Victorian Integrated Cancer Services (VICS) Optimal Care Summits program identifies unwarranted variations against the standards and targets determined in the Optimal Care Pathways (OCP). The program explores the causes of unwarranted variations and identifies clinician and consumer informed improvement priorities. Addressing unwarranted variations in cancer care is challenging, but critical to promoting health equity. This study aimed to determine priority unwarranted variations and targeted action in oesophagogastric cancer (OG) care across Victoria, Australia. During 2023–2024, a mixed methods strategic consultation approach with Victorian OG multidisciplinary stakeholders was applied. It included: rapid literature review and environmental scan; barriers, enablers, and preferences survey of multidisciplinary clinicians; consumer experience reporting; analysis of 2012–2021 linked cancer administrative datasets; and implementation of a Delphi survey to prioritise unwarranted variations to be discussed at a summit event, identification of improvement priorities and action plan. Qualitative data was subject to thematic analysis and quantitative data was subject to descriptive statistical analysis. Both data were then synthesised. Twenty unwarranted variations in OG cancer care and/or outcome were identified and three were prioritised for discussion at the summit event: differing survival among patients living in one regional area, compared to the statewide average, for gastric cancer; variations in time from diagnosis to patients receiving any treatment within 6 weeks for non-metastatic oesophageal cancer; and low rates of OG cancer surgical and/or chemotherapy patients being seen by a dietitian within 3 months of diagnosis. The summit identified causes and produced a statewide action register, prioritising improvements by impact and resources required. This novel mixed methods approach demonstrates an effective strategy for identification of patient perspectives and data-informed unwarranted variations, causes and improvement initiatives for action to promote alignment with tumour specific OCPs.