Regionalization of pancreatic cancer treatment within an integrated healthcare system

Abstract

Presenter: Diana Hsu MD | University of California, San Francisco Background: Studies have shown that pancreaticoduodenectomies performed at higher volume centers result in decreased mortality, length of stay, operating time, and cost compared to those performed at lower volume centers. Kaiser Permanente Northern California (KPNC) implemented regionalization of pancreatic cancer care to Centers of Excellence (CoE) within its integrated healthcare system. This study examines the survival outcomes after the regionalization of care. Methods: A retrospective chart review of 1621 patients undergoing pancreatic cancer treatment from February 2010 and December 2018 was performed. The transitions from 21 hospitals to 4 Centers of Excellence (CoE) included creating high volume pancreatic surgery centers (>25 pancreatic resections per year) and designated specialties, such as medical oncology, radiology, radiation oncology, and pathology. Descriptive statistics were performed, followed by bivariate analysis to assess differences in characteristics according to either the independent or dependent variables. Given that all variables assessed were categorical, Chi squared tests were used to determine differences of statistical significance. Unadjusted and adjusted survival analyses were performed using Kaplan–Meier. Cox proportional hazard regression models were used to determine the association between race and ethnicity and the primary outcome (overall survival in months). All statistical analyses were performed by SPSS version 22. Results: There was no difference in baseline demographics among patients undergoing pancreatic cancer treatment pre and post-regionalization. However, there was a statistically significant difference in pre and post-regionalization number of patients who had 16 or more lymph nodes sampled, 142 (44%) and 219 (69%), respectively (p<.001). There was also an increase in neoadjuvant chemotherapy utilization from 10% to 31%, pre and post-regionalization. The median overall survival (OS) pre and post-regionalization was 11 and 14 months, respectively (p<.001). (Fig 1) Median follow up of patients was 32 months. Conclusion: Regionalization of pancreatic cancer care at KPNC, an integrated hospital system, resulted in improvements in surgical quality outcomes, such as adequate lymph node sampling. Our multidisciplinary approach to CoE encompasses standardization and performance improvements in oncology, radiology, pathology, as well as surgery. The results suggest that regionalization of care in a large integrated healthcare system improves overall survival for patients undergoing pancreatic cancer treatment.