Abstract
Introduction: Although quality of care has become a central aspect of modern medicine, a definite relationship between quality indicators (QIs) and outcomes has not been fully established in patients with pancreatic cancer (PC). The primary aim of this study was to examine the possible association of established process-based QIs with short and long term outcomes in patients undergoing PC resection. Methods: All adult patients undergoing resection for PC in Nova Scotia between 2001 and 2011 were included in a retrospective cohort study. Logistic and Cox model regression analyses were used to test the hypothesis that meeting selected QIs was associated with improved perioperative morbidity, mortality and overall survival. Results: Pancreaticoduoedenectomy was performed in 82 (87%) patients and distal pancreatectomy in 12 patients (13%). Multivariable analysis adjusting for patient and tumour characteristics showed that only preoperative radiological staging obtained within 8 weeks from the date of surgery was associated with better survival (HR for death=0.34, 95% CI=0.14-0.84). Other QIs failed to show any association with perioperative morbidity and mortality and overall survival. Conclusions: With the exception of preoperative staging within the recommended time interval, meeting QIs was not associated with improved short and long term outcome in resected PC patients.
Highlights
Quality of care has become a central aspect of modern medicine, a definite relationship between quality indicators (QIs) and outcomes has not been fully established in patients with pancreatic cancer (PC)
Several groups have reported that PC patients receive one of the lowest rates of cancer-directed therapy among all the solid tumors [4,5,6,7,8,9,10] and treatments may differ based upon patients’ socioeconomic status, place of residence, number of procedures performed in a health system and physician expertise [4,5,6,7,8,9,10]
Patients with PC were identified based on diagnostic codes of the International Classification of Disease for Oncology, 3rd edition (ICD-O-3) using the Nova Scotia Cancer Registry (NSCR), a prospectively maintained provincial registry of all patients affected by malignant diseases
Summary
Quality of care has become a central aspect of modern medicine, a definite relationship between quality indicators (QIs) and outcomes has not been fully established in patients with pancreatic cancer (PC). Besides established prognostic factors such as cellular differentiation, lymph vascular infiltration and tumor stage, there may be other reasons responsible for the low survival rate of these patients. Several groups have reported that PC patients receive one of the lowest rates of cancer-directed therapy among all the solid tumors [4,5,6,7,8,9,10] and treatments may differ based upon patients’ socioeconomic status (education level, income), place of residence (rural vs urban), number of procedures performed in a health system (low vs high volume hospital) and physician expertise [4,5,6,7,8,9,10]
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