Gender and Generational Divide Between Surgeons Regarding Preoperative Palliative Care Referral for Patients with Resectable Pancreatic Cancer: Results from an International Survey

Abstract

INTRODUCTION: Preoperative palliative care (PC) consultation has been proposed for patients with resectable gastrointestinal cancer. Two randomized trials are evaluating PC and surgeon comanagement in the perioperative setting. We hypothesized that pancreatic surgeons harbor significant reservations regarding providing palliative care in parallel with potentially curative surgery. METHODS: An anonymous international web-based survey was conducted in 2021. Chi-square test or Fisher’s exact test were used for categorical questions, and the Wilcoxon test was used for Likert-scaled questions. Statistical significance was set at p < 0.05. RESULTS: A total of 138 surveys were completed. Of these, 83% of surgeons were male, 85% completed a fellowship, 80% practiced in academia, 46% performed more than 30 annual curative-intent operations for PDAC, and 90% had been in practice 30 or fewer years. Of those surveyed, 88% of surgeons were from the US. Of those surveyed, 65% of surgeons supported introducing PC preoperatively; female surgeons (p = 0.018) and fellowship-trained surgeons (p = 0.002) significantly more likely supported this practice; however, surgeons in practice more than 30 years did not support preoperative PC referral (p = 0.003). Of those surveyed, 94% of surgeons identified benefits associated with preoperative PC consultation; female surgeons (p = 0.048; odds ratio 3.03; CI 097. to 9.45) and fellowship-trained surgeons (p = 0.016; odds ratio 4.17; CI 1.30 to 13.33), were more likely to report that preoperative PC consultation may improve symptoms management. US surgeons identified more benefits and challenges related to preoperative PC consultation compared with non-US surgeons. CONCLUSION: Most surgeons recognize the potential benefit of preoperative PC consultation and comanagement. However, gender, fellowship training, and years in practice impact surgeons’ preference. Further studies are needed to elucidate patient and other stakeholder perspectives on preoperative PC-surgeon comanagement.