"White Paper on the Quality of Life of Chinese Gastric Cancer Patients" released: Early gastric cancer is asymptomatic, and the diagnosis and treatment rate is less than 10%

China News Service, Beijing, October 5 (Reporter Zhao Fangyuan) "Early digestive system tumors, especially early gastric cancer, are basically asymptomatic. And waiting for symptoms to appear often misses the best opportunity for discovery." Recently, the "White Paper on the Quality of Life of Chinese Gastric Cancer Patients" (hereinafter referred to as the "White Paper") was officially released. As the leading expert in guiding the "White Paper", Shen Lin, director of the Department of Gastrointestinal Oncology at Peking University Cancer Hospital, accepted an interview with Sino-Singapore Health.

The "White Paper" shows that nearly 70% (69.0%) of patients were diagnosed with the disease after seeking medical treatment due to symptoms. Among patients who sought medical treatment due to symptoms, about 40% (39.8%) delayed seeking medical treatment; when diagnosed, the proportion of stage III and IV patients was as high as 55.2%.

Japan and South Korea carry out routine endoscopy for people over 50 years old, but in my country, this model is difficult to directly replicate. "We have a large population base, and universal screening is not realistically feasible. Excessive universal screening can also easily lead to a waste of medical resources. Therefore, it is necessary to screen out high-risk groups first. Only by accurately identifying high-risk groups, establishing a normalized endoscopic screening mechanism, and carrying out targeted screening can we detect early gastric cancer and improve the overall early diagnosis rate."

Differences in screening systems have also resulted in disparities in survival prognosis between Chinese and foreign gastric cancer patients. Relevant expert consensus shows that the diagnosis and treatment rate of early gastric cancer in my country has long been lower than 10%, in Japan it is about 70%, and in South Korea it is about 50%. "This gap is mainly due to the low early diagnosis rate and the comprehensive treatment level in our country is not low." Shen Lin said.

Currently, gastric cancer has entered the era of precise diagnosis and treatment driven by multiple biomarkers such as HER2, MSI/MMR, Claudin18.2, and PD-L1. The "White Paper" survey shows that 64.7% of patients are very willing or relatively willing to receive new targeted therapies for gastric cancer. However, there is still a large gap between the "knowledge" and "actual detection" of biomarkers. Taking CLDN18.2 as an example, the patient awareness rate reached 63.5%, but the actual detection rate was only 36.9%.

In Shen Lin's view, the bottleneck in testing lies with doctors. "Our country currently does not have a specialist physician system. Many doctors can treat tumors. However, not all doctors have a significantly better understanding of the latest advances in the field of tumors, including biomarker testing, than the public."

His team's data analysis of more than 220,000 gastric cancer patients from 53 hospitals in 27 provinces across the country found that the coverage of standardized molecular testing for gastric cancer in China is insufficient, with less than 2% of patients receiving neoadjuvant therapy. A large number of standardized solutions recommended by authoritative diagnosis and treatment guidelines are difficult to implement in grassroots clinical practice.

In this regard, Shen Lin suggested that regular education should be carried out for the whole society, especially medical staff, to make up for the shortcomings in diagnosis and treatment knowledge of non-oncology specialists. In response to the problem of limited coverage of traditional academic promotion, her team is also exploring the use of artificial intelligence and released a large model of gastrointestinal oncology. "I hope it can become an AI decision-making partner beside doctors in the future."

The "White Paper" also reveals the long-neglected quality-of-life dilemma of gastric cancer patients: 82.4% of patients suffer from mild or above malnutrition, of which 57.5% are moderately or severely malnourished; 87.4% of patients experience varying degrees of social restriction after illness.

"Gastric cancer directly affects the patient's eating and digestive functions. Patients not only have to endure physical pain, but also bear heavy psychological pressure, and family members are also prone to anxiety." Shen Lin said that gastric cancer treatment cannot be limited to a single anti-tumor drug treatment. It must also pay attention to the patient's physiological state, nutritional status and psychological emotions throughout the process, while taking into account the psychological counseling of family members and carrying out all-round, multi-disciplinary comprehensive intervention.

A phase III randomized controlled study published by his team in the Journal of Clinical Oncology in 2021 fully confirmed the clinical value of comprehensive intervention.

This study included 328 patients with newly treated metastatic esophageal and gastric cancer. The results showed that the median overall survival of patients who received early nutritional and psychological multidisciplinary support was 14.8 months, while the median survival of patients who only received conventional standardized anti-tumor treatment was only 11.9 months.

"Food is the most important thing for people. Once you don't eat well, great changes will occur in all aspects of psychology and physiology." Shen Lin pointed out that depression, anxiety, and insomnia will have a great impact on the overall immune system. "This is a multi-disciplinary comprehensive treatment that requires the joint support and maintenance of psychology, physiology, and nutrition. We are treating people with tumors."

She hopes that in the future, tumors can be controlled like hypertension and diabetes, and truly become chronic diseases. (over)