Abstract
In the present study, we aimed to describe, at the population level, patterns of adjuvant treatment use after curative-intent resection for pancreatic adenocarcinoma (pcc) and to identify independent predictors of adjuvant treatment use. In this observational cohort study, patients undergoing pcc resection in the province of Ontario (population 13 million) during 2005-2010 were identified using the provincial cancer registry and were linked to administrative databases that include all treatments received and outcomes experienced in the province. Patients were defined as having received chemotherapy (ctx), chemoradiation (crt), or observation (obs). Clinicopathologic factors associated with the use of ctx, crt, or obs were identified by chi-square test. Logistic regression analyses were used to identify independent predictors of adjuvant treatment versus obs, and ctx versus crt. Of the 397 patients included, 75.3% received adjuvant treatment (27.2% crt, 48.1% ctx) and 24.7% received obs. Within a single-payer health care system with universal coverage of costs for ctx and crt, substantial variation by geographic region was observed. Although the likelihood of receiving adjuvant treatment increased from 2005 to 2010 (p = 0.002), multivariate analysis revealed widespread variation between the treating hospitals (p = 0.001), and even between high-volume hepatopancreatobiliary hospitals (p = 0.0006). Younger age, positive lymph nodes, and positive surgical resection margins predicted an increased likelihood of receiving adjuvant treatment. Among patients receiving adjuvant treatment, positive margins and a low comorbidity burden were associated with crt compared with ctx. Interinstitutional medical practice variation contributes significantly to differential patterns in the rate of adjuvant treatment for pcc. Whether such variation is warranted or unwarranted requires further investigation.
Highlights
Pancreatic adenocarcinoma remains a challenging disease to treat, with almost all patients being diagnosed at an advanced stage[1]
Compared with previous population-level analyses conducted using data from the United States, the analyses in the present study showed that a substantially greater proportion of patients received adjuvant treatment (75% vs. 55% –58%), the proportion reported here was similar to that in a more recent population-based study conducted in Australia (76%)[8,9,23]
Possible explanations for the foregoing observations include the temporal trend of increasing rates of adjuvant treatment observed in the current study, as well as the availability of public health insurance covering the costs of adjuvant treatment in Canada and Australia
Summary
Pancreatic adenocarcinoma (pcc) remains a challenging disease to treat, with almost all patients being diagnosed at an advanced stage[1]. Reports of patients undergoing resection for pcc reveal that up to 50% receive no adjuvant treatment, but just observation (obs) after curative-intent surgery[7,8,9]. Previous investigations have identified greater age, major perioperative complications, poor preoperative performance status, and favourable histopathologic features as predictors of not receiving adjuvant treatment[7,10,11,12]; the literature is limited to studies performed at a single institution or a small group of institutions, which might not reflect findings at a population level, where patients are treated by disparate practitioners with varying practice and referral patterns[13]. We sought to identify, at the population level, independent predictors of receiving adjuvant ctx or crt, or obs in patients undergoing curative-intent resection of pcc. We aimed to describe, at the population level, patterns of adjuvant treatment use after curative-intent resection for pancreatic adenocarcinoma (pcc) and to identify independent predictors of adjuvant treatment use
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