Table 1 Published standards on which the survey questionnaires were based

1. Treatment for patients with oesophageal cancer should be the responsibility of Specialist Oesophago-gastric Cancer Teams based in Cancer Units or Cancer Centres which would normally serve populations of at least one million. (IOG, p45)

1. The specialist palliative care team should be multi-professional, and should, as a minimum, include a palliative care physician and palliative care nurse specialists. (IOG, p61)

2. There should be 24-hour on-call consultant specialist surgical cover for postoperative care. Note: To achieve this measure at least 3 specialist consultant surgeons per team would be needed. (MCS, measure 2F-227)

2. A palliative care specialist should be a member of the Specialist Oesophago-Gastric Cancer Team and the Local Upper Gastro-intestinal Cancer Care Team. (IOG, p29-31)

3. The stage and spread of the cancer should be assessed using computed tomography (CT) or magnetic resonance scanning. If the patient is sufficiently fit to undergo radical treatment and imaging produces no evidence of widespread or metastatic disease, endoscopic ultrasound (EUS) should be used to estimate the depth of tumour penetration. If this also suggests that radical treatment could be successful, patients whose tumours could involve the peritoneal cavity should proceed to laparoscopy. (IOG, p37)

3. From the time of assessment, each patient should have access to a named clinical nurse specialist who can offer support and continuity of care. (IOG, p32)

4. Laser or photodynamic therapy should be used for initial control of obstructive symptoms caused by exophytic tumours in the oesophagus. Partially covered self-expanding metal stents should be used to control obstructive oesophageal symptoms either following or instead of laser therapy, depending on the availability of local expertise. (SIGN, p33-35)

4. Specialist advice should be available from a dietician. This should focus on helping patients to achieve adequate nutrition. Patients who have undergone surgery for oesophageal or gastric cancer should be given guidance to help them deal with post-surgical syndromes which can cause problems with eating. (IOG, p21-22)

5. Palliative chemotherapy should start within 2 weeks and ideally within 48 hours, depending on symptom severity. Chemotherapy with curative or adjuvant intent should start within 3 weeks and ideally within 1 week. Urgent radiotherapy, e.g., for spinal cord compression or superior vena cava obstruction, should start within 24 hours of referral. Palliative radiotherapy should start within 2 weeks and ideally within 48 hours, depending on symptom severity. Radical radiotherapy should start within 4 weeks and ideally within 2 weeks. (RCR)

5. All patients should be screened using a validated screening tool to assess nutritional risk. (SIGN, p24)