Abstract
BackgroundDespite national recommendations, disparities in specialised palliative care (SPC) admittance have been reported. The aims of this study were to characterize SPC admittance in patients with pancreatic cancer in relation to region of residence and age.MethodThe data sources were two nationwide databases: Danish Pancreatic Cancer Database and Danish Palliative Care Database. The study population included patients (18+ years old) diagnosed with pancreatic cancer from 2011 to 2018. We investigated admittance to SPC, and time from diagnosis to referral to SPC and first contact with SPC to death by region of residence and age.ResultsIn the study period (N = 5851) admittance to SPC increased from 44 to 63%. The time from diagnosis to referral to SPC increased in the study period and overall, the median time was 67 days: three times higher in Southern (92 days) than in North Denmark Region. The median number of days from diagnosis to referral to SPC was lower in patients ≥70 years (59 days) vs patients < 70 years (78 days), with regional differences between the age groups. Region of residence and age were associated with admittance to SPC; highest for patients in North Denmark Region vs Capital Region (OR = 2.03 (95%CI 1.67–2.48)) and for younger patients (< 60 years vs 80+ years) (OR = 2.54 (95%CI 2.05–3.15)). The median survival from admittance to SPC was 35 days: lowest in Southern (30 days) and highest in North Denmark Region (41 days). The median number of days from admittance to SPC to death was higher in patients < 70 years (40 days) vs ≥ 70 years (31 days), with a difference between age groups in the regions of 1–14 days.ConclusionsFrom 2011 to 2018 more patients with pancreatic cancer than previously were admitted to SPC, with marked differences between regions of residence and age groups. The persistently short period of time the patients are in SPC raises concern that early integrated palliative care is not fully integrated into the Danish healthcare system for patients with pancreatic cancer, with the risk that the referral comes so late that the patients do not receive the full benefit of the SPC.
Highlights
Despite national recommendations, disparities in specialised palliative care (SPC) admittance have been reported
The time from diagnosis to referral to SPC increased in the study period and overall, the median time was 67 days: three times higher in Southern (92 days) than in North Denmark Region
Region of residence and age were associated with admittance to SPC; highest for patients in North Denmark Region vs Capital Region (OR = 2.03 (95%confidence intervals (CIs) 1.67–2.48)) and for younger patients (< 60 years vs 80+ years) (OR = 2.54 (95%CI 2.05–3.15))
Summary
Disparities in specialised palliative care (SPC) admittance have been reported. The majority of patients with pancreatic cancer are older than 60 years and have advanced disease at time of diagnosis [2]. Adsersen et al BMC Palliative Care (2021) 20:192 percent of the patients will die within 2 months of initial diagnosis [3, 4], and 9% are alive 5 years after diagnosis [1]. Palliative chemotherapy is the standard treatment for patients with advanced disease and has led to a benefit in overall survival [5,6,7]; the effect on quality of life (QoL) improvement is less clear. Patients with pancreatic cancer often experience complex symptomatology such as pain, fatigue, malnutrition [8] and pancreatic exocrine insufficiency, which together with treatment toxicities can contribute to a poor QoL and psychological distress [9]
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