Revealing the gaps - unwarranted variations and multidisciplinary solutions in Victorian oesophagogastric cancer care - A mixedmethods analysis

Sep 22, 2026

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An unwarranted variation in cancer care and/or outcome reflects disparity not explained by differences in patient illness or preferences. Using the Victorian Integrated Cancer Services Optimal Care Summits within Optimal Care Pathways, the study set priorities for unwarranted variations and targeted action in oesophagogastric cancer care across Victoria, Australia. A mixed-methods strategy consulted multidisciplinary stakeholders, analysed linked datasets from 2012–2021, surveyed barriers and preferences, and synthesised qualitative themes with descriptive statistics.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Introduction

Unwarranted variations and care standards

Methods

Mixed-methods consultation and data analysis

Results

Prioritised unwarranted variations and summit outputs

Conclusion

Data-informed action to promote equity

Graham etal. BMC Health Services Research (2026) 26:827 BMC Health Services Research [https://doi.org/10.1186/s12913-026-14554-7](https://doi.org/10.1186/s12913-026-14554-7) RESEARCH Open Access Revealing the gaps: unwarranted variations and multidisciplinary solutions in Victorian oesophagogastric cancer care—A mixedmethods analysis Frances F. Graham 1*, Helena Rodi 1, Nicklause Baje1, Paul Cashin2, David S. Liu3,4,5, Wanyu Chu6, Norah Finn6, Tommy Hon Ting Wong6 and Linda Nolte 1,7* Abstract Introduction 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 inoesophagogastric cancer (OG) care across Victoria, Australia. Methods 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. Results 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. *Correspondence: Frances F. Graham [frances.graham@austin.org.au](frances.graham@austin.org.au)[ ](frances.graham@austin.org.au)Linda Nolte [linda.nolte@austin.org.au](linda.nolte@austin.org.au) Full list of author information is available at the end of the article © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/licenses/by-nc-nd/4.0/](vecommons.org/licenses/by-nc-nd/4.0/.)[.](vecommons.org/licenses/by-nc-nd/4.0/.) Graha

FAQs

What does “unwarranted variation” mean in this study?

It refers to differences in cancer care and/or outcomes that are not explained by differences in patient illness or preferences.

What approach and data sources were used to identify unwarranted variations?

A mixed-methods consultation was conducted, including rapid literature review and an environmental scan, clinician barriers/enablers and preferences surveys, consumer experience reporting, analysis of linked administrative cancer datasets (2012–2021), and a Delphi survey to prioritise variations.

Which unwarranted variations were prioritised for the summit event?

Three were prioritised: regional vs statewide survival differences for gastric cancer, longer time from diagnosis to treatment within 6 weeks for non-metastatic oesophageal cancer, and low dietitian review rates within 3 months of diagnosis among OG cancer surgical and/or chemotherapy patients.

Sep 22, 2026

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