New study aims to improve treatment pathways for patients with oesophageal cancer

A new study is aiming to improve and standardise the way decisions are made about the best treatment for patients with a hard-to-treat cancer.

Currently, there are wide variations across the country in the way that tests are used to assess patients with cancer of the oesophagus (food pipe) and it’s feared this could mean there is inequality in decisions about how they are treated.

The VALUE study will assess the usefulness of a test called an endoscopic ultrasound (EUS), which involves putting a camera down the oesophagus, and how this could affect treatment pathways. The study is being run by researchers at Cardiff University and coordinated by the Southampton Clinical Trials Unit.

Deciding on the best treatment

Oesophageal cancer is often diagnosed at a late stage when the cancer may have already spread and there are fewer treatment options available. Because of this, just 1 in 10 patients with this type of cancer survive more than 5 years after diagnosis.

To decide on the best course of treatment for an individual patient, doctors will use scans to assess the cancer and the surrounding tissues and organs to see whether the disease has spread.

One of the tests available is an endoscopic ultrasound (EUS) which uses a flexible camera that is inserted through the patient’s mouth and passed down the oesophagus so that the doctor can examine the cancer and the surrounding area.

“We know from a UK-wide survey of doctors who treat oesophageal cancer that the use of EUS scans varies widely amongst different hospitals,” says Dr Kieran Foley, consultant radiologist at the Royal Glamorgan Hospital and Velindre Cancer Centre, clinical senior lecturer at Cardiff University and Chief Investigator of the VALUE study.

“There is also limited evidence for exactly how useful the EUS scan is compared to other methods such as PET scans. This, combined with unequal access to EUS across the UK, could potentially lead to different decisions on how patients are treated between the hospitals using EUS and those where it is not used.”

Finding the evidence

To help answer the question about whether EUS is an effective tool for making treatment decisions and whether it should therefore be used more widely, Dr Foley is working with the team at the Southampton Clinical Trials Unit to run the VALUE study.

180 patients will be recruited to take part in the study at eleven UK oesophageal cancer centres.

“Doctors will be asked to record what the best treatment plan for each patient would have been, before knowing the results of the EUS,” says Ben Lindfield from Southampton Clinical Trials Unit. “They will then re-consider the treatment decision using the new information that EUS provides. This will help us to understand how EUS changes treatment decisions.

“Patients and doctors will also be asked to complete interviews about their thoughts and experiences regarding EUS, to help the team better understand how and why decisions about EUS are made, and when it might be most effective.”

The VALUE study is now open and recruiting patients at University Hospital Southampton, Castle Hill Hospital, Hull and Glasgow Royal Infirmary.   The study will be opening at a further eight sites across the UK.

Dr Foley continues: “Using the evidence gathered in the VALUE study, we hope to be able to make recommendations about the usefulness of EUS for doctors making treatment decisions for patients with oesophageal cancer, and whether EUS should therefore be used more consistently across UK hospitals.”

The VALUE study is being funded by a research grant from the National Institute for Health and Care Research (NIHR).