Category of presentation: Gastric Cancer
Type of presentation: Oral presentation.
GASTRIC CANCER AND SIMULTANEOUS CARE: PRELIMINARY REPORT ABOUT THE TAKE CHARGE APPROACH. 
Alberto Vannelli 1, Raffaele Bellotti 1, Giulio Capriata 1, Fiorenzo Giacci 1, Claudio Murmura 1, Antonella Putortì 2, Fabrizio Rossi 1, Michel Zanardo 1.

1 Division of Surgical Oncology Valduce Hospital, Como, Italy; 2 University of Policlinico “G. Martino”, Messina, Italy.

Aim of study
In multimodal therapy era, surgery is considered the main treatment for gastric cancer (GC). Yet, the main topic of National Health Service is GC treatments’ costs. In Italy, the cost due to GC’s care, results in loss of productivity (LP), and is 134% higher than average cancer costs. Among its proposed actions, “National Cancer Plan” intends to reduce migration of the health care and better utilize the available resources so to reduce LP‘s. We present our preliminary results of the first italian simultaneous care model with the intent to increase relationship between oncology and territory, and reduce treatment costs.

Materials and methods
Como has 600.000 people. Incidence of GC, standardized for age, is the highest in North Italy: 18,7 vs 17,1. An average of 110 patients/year undergo a GC surgery, with a migration value of 30%-35%. Erone onlus (oncological volunteer association) has organized a plan of simultaneous care model. In February 2014, in collaboration with Valduce (religious hospital), organized a two-days conference on “Oncology and territory”. The first day dedicated for everybody while the second day for general practitioners (GP). After a year, we examined and compared the results with the historic database of Como Local Health Authority

Main results and conclusions 
Como has a “Dipartimento Interaziendale Provinciale Oncologico”, that treats all oncological patients, nonetheless in 2013 the migration index was of 30,5%. Following our event in 2014, that had an attendance of over 600 people, the migration index decreased to 24,5%. A cutback of migration of health care means a better use of the available resources. Compared to 2013, gastroscopy increased of 4% (up 27% in surgery endoscopy); a sign that GPs paid more importance to upper gastrointestinal symptoms of their patients. Moreover in 2015, first time in Italy, Valduce described an integrated multidisciplinary clinical protocol, on treatment of GC. As the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death, GC is a major clinical and financial burden with significant differences in territorial distribution. Multimodal progress is extremely costly and the results often end in marginal survival benefit, therefore, excellence in surgery should be achieved. A new program for a simultaneous care model is one of several changes required to improve the intended actions of GC surgical treatment. Our preliminary results on this model, demonstrate an advantage in territory, reducing the migration index.