Outcomes and care patterns for advanced pancreatic cancer patients treated in tertiary vs regional/community cancer centres in Northern Alberta.

Abstract

163 Background: Cancer care in Northern Alberta (Canada) is delivered at a single tertiary cancer centre, and 11 regional and community cancer centres (RCCC). We compared outcomes and care patterns for patients with advanced pancreatic cancer (APC; locally advanced or metastatic) in Northern Alberta treated with palliative chemotherapy at either the tertiary centre or an RCCC. Methods: This is a retrospective cohort analysis of APC patients treated with palliative chemotherapy from 2012-2015 in Northern Alberta (Canada). Data were obtained from outpatient medical oncology and palliative care notes and the provincial cancer registry. Survival analysis used a multivariate Cox-regression model. All other tests were Chi-squared/Fisher’s Exact. Results: We identified 106 patients, 90 treated in the tertiary centre, and 16 in a RCCC. Baseline characteristics were not significantly different. There were significant differences in first line chemotherapy regimen use (P = 0.037), with patients treated at RCCC more likely to receive gemcitabine during the study period (68.8% vs 36.6%), and less likely gemcitabine/nab-paclitaxel (12.5% vs 36.5%) or FOLFIRINOX (18.8% vs 28.7%). Patients treated at RCCC were less likely to see an outpatient palliative care physician (P = 0.020, 6.3% vs 35.6%), or have a documented goals of care designation (P = 0.005, 12.5% vs 52.2%). There was no significant difference in overall survival in a multivariate analysis (median 199 vs 232 days, HR = 1.080, 95% CI 0.594 – 1.966). Conclusions: We found that survival was not different for APC patients treated at the tertiary vs RCCC in Northern Alberta. However there were significant differences in the use of palliative care resources and 1st line chemotherapy regimens, which represent important disparities that should be the focus for future quality improvement.