Abstract
BackgroundTo describe patterns of referral, consultation, and treatment of advanced pancreatic cancer patients in a population‐based health care system and to evaluate the impact of these factors on outcomes.MethodsThis is a retrospective analysis of population‐based cancer data from the province of Alberta, Canada. We analyzed patients diagnosed with either locally advanced or metastatic pancreatic adenocarcinoma from 2009 to 2016 and evaluated their patterns of referral to a cancer center, consultation with oncology, and treatment with active anticancer therapies. Logistic regression models were constructed to determine the factors associated with referral, late oncology assessment, and late receipt of treatment.ResultsWe identified 1621 pancreatic cancer patients. Median age was 70 years, 50% were men, and 51% had a Charlson index of 2+. Within this cohort, only 884 (54%) patients were referred to one of the provincial cancer centers. Adjusting for confounders in logistic regression models, older age and worse comorbidity scores were associated with nonreferral (both P < 0.01). In multivariable analysis among treated patients, the following factors were associated with improved overall survival, including younger age, earlier stage, and better comorbidity scores (all P < 0.01). Neither referral to consultation times nor consultation to treatment times correlated with outcomes. Importantly, nonreferred patients were more likely to use acute care services, including longer total duration of hospitalizations and more frequent visits with physician specialists.ConclusionA significant proportion of patients with advanced pancreatic cancer were never referred to a cancer center. Nonreferred patients were more likely to utilize specific health care resources.
Highlights
Despite recent advances in cytotoxic and targeted therapies in oncology, advanced pancreatic cancer remains a highly morbid disease with only limited improvements in survival outcomes.[1]
The current study evaluates patterns of referral, consultation, and treatment of patients with advanced pancreatic cancer in a population‐based setting
It demonstrated that close to half of patients were not referred to a cancer center for consultation, which was especially evident among older patients as well as those with multiple comorbidities
Summary
Despite recent advances in cytotoxic and targeted therapies in oncology, advanced pancreatic cancer remains a highly morbid disease with only limited improvements in survival outcomes.[1]. Pancreatic cancer is known for its late diagnosis, with the majority of patients presenting with unresectable disease at the time of initial diagnosis.[6]. The reason for this is likely secondary to nonspecific symptoms, such as abdominal discomfort and general malaise, which can be frequently confused with the symptoms of less serious diseases.[7]. Detection is further complicated by the fact that pancreatic cancer often develops in elderly patients who have multiple comorbidities for which they are prescribed different medications.[8]. It is not uncommon for symptoms of pancreatic cancer to be incorrectly attributed to these comorbidities or concomitant drugs.[9]. We further hypothesized that these deficiencies may result in increased use of health care services since inappropriately managed patients are more likely to experience symptoms and problems that require downstream medical attention, mainly in acute or urgent care settings
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