Pancreatic Cancer Care Research Articles

Supportive care (SC) utilization for patients with locally advanced pancreatic cancer: Review of the National Cancer Data Base (2004-2018).

4154 Background: Pancreatic cancer is a formidable malignancy, with an estimated 62,000 new cases in 2022 and approximately 50,000 deaths. Five-year overall survival remains low at 11%; 14.4% for locally advanced disease. Nearly one-third of newly diagnosed patients (pts) present with locally advanced pancreatic cancer (LAPC) and only a minority of pts (<25%) are eligible for surgical resection. Given the significant morbidity and mortality associated with LAPC, timely integration of SC into the treatment care plan is vital. Methods: Pts diagnosed with Stage II-III LAPC (2004-2018) recorded in the National Cancer Data Base were included, stratified by stage and use of SC (defined as procedures or therapy provided for palliative intent symptom control) from time of diagnosis throughout the disease trajectory. Analyses included tumor characteristics, demographics, and socioeconomic parameters. Multivariate logistic regressions were performed on three sets of data: Stage II, Stage III, and Stage II/III combined. Results: 158,340 pts were included in the cohort [stage II (70.6%); stage III (29.4%)]. Only a minority of pts (2.9%) received SC treatment despite > 65% of pts receiving care at an academic program; 95% living in or near a metro area, and nearly 60% living < 20 miles of their primary treatment center (p <0.001). Medicare (58%) and private insurance (32.8%) was consistent across both stages and SC use. The table depicts selected significant factors and the respective adjusted odds of receiving SC from the three logistic regressions. Conclusions: Our analysis demonstrates the underutilization of SC in LAPC population over the past decade and potential specific demographic/social areas of unmet need. Future work should focus on practice patterns across cancer centers and the significant impact SC has on both survival and quality of life outcomes for LAPC pts. SC should be an integral component incorporated early on in the care of pancreatic cancer regardless of stage. [Table: see text]

Socioeconomic Predictors of Access to Care for Patients with Operatively Managed Pancreatic Cancer in New York State

PurposeWe evaluated how race and socioeconomic factors impact access to high-volume surgical centers, treatment initiation, and postoperative care for pancreatic cancer in a state with robust safety net insurance coverage and healthcare infrastructure. MethodsThe New York Statewide Planning and Research Cooperative System was analyzed. Patients with pancreatic cancer resected from 2007 to 2017 were identified by ICD and CPT codes. Primary outcomes included surgery at low-volume facilities (<20 pancreatectomies/year), time to therapy initiation, and time to postoperative surveillance imaging (within 60–180 days after surgery). ResultsIn total, 3312 patients underwent pancreatectomy across 124 facilities. Median age was 67 years (IQR 59, 75) and 55% of patients were male. Most (72.7%) had surgery at high-volume centers. On multivariable analysis, odds ratios for surgery at low-volume centers were increased for Black race (2.21 (95% CI 1.69–2.88)), Asian race (1.64 (95% CI 1.09–2.43)), Hispanic ethnicity (1.68 (95% CI 1.24–2.28)), Medicaid insurance (2.52 (95% CI 1.79–3.56)), no insurance (2.24 (95% CI 1.38–3.61)), lowest income quartile (3.31 (95% CI 2.14–5.32)), and rural zip code (2.49 (95% CI 1.69–3.65)). Patients treated at low-volume centers waited longer to initiate treatment (hazard ratio (HR) 0.91 (95% CI 0.81–1.01)). Black patients underwent the least surveillance imaging (50.4%; p <0.0001), while Asian (HR 2.04, 95% CI 1.40–2.98)) and Hispanic patients (HR 1.36 (95% CI 1.00–1.84)) were more likely to have surveillance imaging. ConclusionsRace independently affected access to high-volume facilities and surveillance imaging. When considered in light of other accumulating evidence, future efforts might investigate the perceptions and logistical considerations noted by providers and patients alike to identify the etiology of these disparities and then institute corrective measures.

Toward Precision Pancreatic Cancer Care.

Toward Precision Pancreatic Cancer Care.

Management and Outcomes of Pancreatic Cancer in French Real-World Clinical Practice.

Simple SummarySurgical resection is the only potentially curative treatment for pancreatic cancer, and its indication relies on precise imaging criteria and on patients’ operability. Chemotherapy is recommended, except for patients a with very short life expectancy. We sought to provide real-world information on the management and outcomes of pancreatic cancer. Among patients with a surgically resectable tumor, only half of those aged 75–84 and none after 85 actually underwent resection, even though the prognosis following pancreatectomy in elderly patients was similar to that in younger patients. Patients’ refusal of chemotherapy increased from 7% before 75 years to 73% after 85 years. These results underline the need to develop guidelines for the management of elderly patients with pancreatic cancer and to generalize geriatric assessments.Background: Our objective was to describe real-world patterns of care and outcomes in pancreatic cancer. Methods: 912 patients diagnosed with pancreatic cancer from 2014 to 2017 were registered by the population-based cancer registry of Burgundy (France). Progression-free and net survival were estimated. Results: at diagnosis, 52% of tumors were associated with metastases. Among the 20% of patients fulfilling resectability criteria, half of those aged 75–84 years and none of those ≥85 years actually underwent resection. Age was not associated with 3-year observed survival in patients who underwent resection. Overall, 77% of patients aged <75 years, 55% of those aged 75–84 years and 8% of those ≥85 years received chemotherapy. Among patients who were offered chemotherapy, 73% of those aged ≥85 years refused. Chemotherapy toxicity was higher with Gemcitabine_Oxaliplatin/Gemcitabine_Abraxane and FOLFIRINOX than with Gemcitabine alone. Patients resected after induction FOLFIRINOX and those treated with adjuvant Gemcitabine presented the lowest risk of progression. Three-year net survival was 35% in patients with non-metastatic resectable tumors and under 10% for other patients. Conclusions: Only half of patients aged 75–84 years with a resectable tumor actually underwent resection. Two thirds of patients aged ≥85 years refused chemotherapy, thus underlining the need to expand geriatric assessments.

Differences in receipt of multimodality therapy by race, insurance status, and socioeconomic disadvantage in patients with resected pancreatic cancer.

Background and MethodsRacial and socioeconomic disparities in receipt of adjuvant chemotherapy affect patients with pancreatic cancer. However, differences in receipt of neoadjuvant chemotherapy among patients undergoing resection are not well‐understood. A retrospective cross‐sectional cohort of patients with resected AJCC Stage I/II pancreatic ductal adenocarcinoma was identified from the National Cancer Database (2014–2017). Outcomes included receipt of neoadjuvant versus adjuvant chemotherapy, or receipt of either, defined as multimodality therapy and were assessed by univariate and multivariate analysis.ResultsOf 19 588 patients, 5098 (26%) received neoadjuvant chemotherapy, 9624 (49.1%) received adjuvant chemotherapy only, and 4757 (24.3%) received no chemotherapy. On multivariable analysis, Black patients had lower odds of neoadjuvant chemotherapy compared to White patients (OR: 0.80, 95% CI: 0.67–0.97) but no differences in receipt of multimodality therapy (OR: 0.89, 95% CI: 0.77–1.03). Patients with Medicaid or no insurance, low educational attainment, or low median income had significantly lower odds of receiving neoadjuvant chemotherapy or multimodality therapy.ConclusionsRacial and socioeconomic disparities persist in receipt of neoadjuvant and multimodality therapy in patients with resected pancreatic adenocarcinoma.DiscussionPolicy and interventional implementations are needed to bridge the continued socioeconomic and racial disparity gap in pancreatic cancer care.

Enhancing the cost-effectiveness of surgical care in pancreatic cancer: a systematic review and cost meta-analysis with trial sequential analysis.

Clinical pathways (CP) based on Enhanced recovery after surgery (ERAS®) are increasingly utilised in patients undergoing pancreatoduodenectomy (PD). This systematic review aimed to compare the impact of CPs versus conventional care (CC) on peri-PD costs. A systematic review of major reference databases was undertaken. Quality assessment was performed using the CHEERS checklist. Incremental cost-effectiveness ratios were calculated as part of the cost-effectiveness analysis. A meta-analysis was performed using random-effects models and Trial sequential analysis (TSA) was used to assess the precision and conclusiveness of the results. 14 studies meeting inclusion criteria were included for full qualitative synthesis. All studies reported a reduction in overall costs, length of stay and overall complication rates for CPs when compared to CC. Meta-analysis performed on nine studies demonstrated significantly reduced costs in the CP group, with considerable heterogeneity (Pooled mean difference of $ 4.28×103, p<0.01, I2=95%). Cost-effectiveness analysis in relation to complications demonstrated dominance of CPs over CC in being cheaper as well as more effective. TSA supported the cost benefit of enhanced-recovery CPs, displaying minimal type 1 error. Peri-PD CPs result in significant cost-reduction in comparison to CC.

Is the Criteria for Direct Access to CT Scans in Primary Care for Suspected Pancreatic Cancer Being Met?

Is the Criteria for Direct Access to CT Scans in Primary Care for Suspected Pancreatic Cancer Being Met?

Disparities in pancreatic cancer care and research in Native Americans: Righting a history of wrongs.

Disparities in pancreatic cancer incidence and outcomes exist in Native American populations. These disparities are multifactorial, difficult to quantify, and are influenced by historical, socioeconomic, and health care structural factors. The objective of this article was to assess these factors and offer a call to action to overcome them. The authors reviewed published data on pancreatic cancer in Native American populations with a focus on disparities in incidence, outcomes, and research efforts. The historical context of the interactions between Native Americans and the United States health care system was also analyzed to form actionable items to build trust and collaboration. The incidence of pancreatic cancer in Native Americans is higher than that in the general US population and has the worst survival of any major racial or ethnic group. These outcomes are influenced by a patient population with often poor access to high-quality cancer care, historical trauma potentially leading to reduced care utilization, and a lack of research focused on etiologies and comorbid conditions that contribute to these disparities. A collaborative effort between nontribal and tribal leaders and cancer centers is key to addressing disparities in pancreatic cancer outcomes and research. More population-level studies are needed to better understand the incidence, etiologies, and comorbid conditions of pancreatic cancer in Native Americans. Finally, a concerted, focused effort should be undertaken between nontribal and tribal entities to increase the access of Native Americans to high-quality care for pancreatic cancer and other lethal malignancies.

Could Total Neoadjuvant Therapy Followed by Surgical Resection Be the New Standard of Care in Pancreatic Cancer? A Systematic Review and Meta-Analysis.

Background. Total neoadjuvant therapy (TNT), intended as induction chemotherapy (IC) followed by radio-chemotherapy (RCT), has been taking hold in the treatment of pancreatic ductal adenocarcinoma (PDAC). The aim of this review is to summarize the available evidence on the role of TNT followed by curative surgery. Methods. Eligible studies were those reporting on patients with PDAC undergoing curative surgery after TNT. The primary endpoint was overall survival (OS). Results. A total of 1080 patients with PDAC who had undergone TNT were analyzed. The most common IC regimen was Gemcitabine (N 620, 57%). Toxicity during IC varied from 14% to 51%. Disease progression during IC varied from 3% to 25%. 607 (62%) patients underwent curative surgery after IC + CRT. In meta-analysis, the available data on lymph node metastases radicality and 2 years OS had better results in favor of TNT groups (OR 1.77, 95% CI 1.20–2.60, p = 0.004 and OR 2.03, 95% CI 1.19–3.47, p = 0.01 and OR 1.64, CI 1.09–2.47, p = 0.02, respectively). Conclusions. Despite the heterogeneity of the studies, different selection criteria, and non-negligible drop-out rate, TNT demonstrated a potential superiority to NAT without CRT in oncological and pathological outcomes, even if the main differences seem to depend on the IC regimen.

The impact of CA 19-9 on survival in patients with clinical stage I pancreatic cancer.

606 Background: Standard of care for early-stage resectable pancreatic cancer (PC) includes a combination of surgical resection and chemotherapy. Frequently, CA 19-9 is used as a biomarker to monitor treatment effect and has prognostic significance. We evaluated the impact of CA 19-9 on overall survival (OS) in patients with clinical stage I PC (cT1N0 and cT2N0) utilizing the National Cancer Database (NCDB). Methods: The NCDB was queried between 2010 and 2014 to identify patients with clinical stage I PC. Patients who had missing or undocumented CA 19-9 value at diagnosis were excluded. Demographic and clinical characteristics were analyzed. Patients were stratified into two cohorts based on the CA 19-9 value at diagnosis – CA 19-9 &lt; 98 U/mL and CA 19-9 &gt; 98 U/mL. Univariable and multivariable analyses were performed, and variables associated with OS were identified. Kaplan-Meier survival curves were computed to compare the OS between the two cohorts. Results: A total of 12,480 patients met our inclusion criteria. A majority of patients were female (51.9%), white (84.4%), with a median age of 70 years. Nearly, half the patients received care in an academic/research program (49.5%). A majority of patients had tumors located in the head of the pancreas (71.9%), and received single-agent (35.1%) or multiagent (22.9%) chemotherapy. Over half the patients (6505 patients, 52.1%) had a CA 19-9 value &gt; 98 U/mL. A CA 19-9 value &gt; 98 U/mL in patients predicted a significantly shorter median OS of 12.1 months compared to 19.4 months in patients with a CA 19-9 &lt; 98 U/mL, p&lt;0.0001 (Table). The 5-year OS rate was 9.9% in patients with a CA 19-9 value of &gt; 98 U/mL compared to a 5-year OS rate of 18.1% for patients with a CA 19-9 value &lt; 98 U/mL. On multivariable analysis, CA 19-9 &gt; 98 compared to CA 19-9 &lt; 98 (HR 1.53, p&lt;0.001) and black race compared to white race (HR 1.10, p&lt;0.001) was associated with worse survival, whereas tumor location in the body and tail compared to the head (HR 0.82, p&lt;0.001), single-agent (HR 0.55, p&lt;0.001) and multiagent (HR 0.55, p&lt;0.001) chemotherapy compared to no chemotherapy, independently predicted improved OS. Conclusions: This is the first National Cancer Database study to demonstrate the prognostic value of CA 19-9 in patients with clinical stage I pancreatic cancer, with a value &lt; 98 U/mL predicting improved survival. Clinical stage I pancreatic cancer patients appear to derive a significant benefit from chemotherapy, including single and multiagent chemotherapy, irrespective of the CA 19-9 value.[Table: see text]

Palliative care and end-of-life care in metastatic pancreatic cancer.

544 Background: Patients with metastatic pancreatic cancer (mPC) have a 5-year survival of 2.7%. Studies have shown that patients with mPC receive aggressive end of life (EOL) care which has been associated with worse quality of life for patients and high use of resources when they are least likely to benefit patients. Methods: A retrospective database of patients with mPC treated at Fox Chase Cancer Center between 2010 and 2019 was analyzed for utilization of palliative care and EOL care. Statistical analysis was performed using one-sample Z tests calculated in Excel. Results: We identified 610 patients with mPC, of whom 39% received palliative care, 56% were referred to hospice, and 91.8% are deceased. The average time from mPC diagnosis to palliative care consult was 232 days, the average time from palliative care consult to death was 121 days. Patients who received palliative care were less likely to receive chemotherapy within 14 days of death (7.7% vs 13.3%, p =0.05), more likely to have a DNR code status (83.3% vs 44.5%, p &lt; 0.0001), and more likely to be referred to hospice (83.9% vs 35.9%, p &lt; 0.0001). The average length of time on hospice was 24 days with no difference between those who received palliative care and those who did not. Patients who were referred to hospice were also less likely to receive chemotherapy within 14 days of death (6.7% vs 19.8%, p &lt; 0.0001). Conclusions: Patients with mPC who had a palliative care team involved in their care were significantly less likely to receive aggressive EOL care.

Disparities in Access to Oncologic Care in Pancreatic Cancer: A Systematic Review.

Pancreatic cancer care is complex, and multiple disparities in receipt of therapies have been documented. The authors aimed to conduct a systematic review of the literature to critically assess and summarize disparities in access to oncologic therapies for pancreatic cancer. A search of PubMed, Scopus, Web of Science, and Cochrane databases were performed for studies reporting disparities in access to oncologic care for pancreatic cancer. Primary research articles published in the United States from 2000 to 2020 were included. Data were independently extracted, and risk of bias was assessed using the modified Newcastle-Ottawa scale. The inclusion criteria were met by 47 studies. All the studies used retrospective data, with 70 % involving national database studies, 41 assessing the impact of race/ethnicity, 22 assessing the impact of socioeconomic status, 18 assessing the impact of insurance status, 23 assessing the impact of gender, 26 assessing the impact of age, and 3 assessing the impact of location on the delivery of cancer-directed therapies. Race, socioeconomic status, insurance status, gender, and age- based disparities in receipt of surgical resection, treatment at high-volume facilities and multimodal therapy for resectable pancreatic cancer, receipt of systemic chemotherapy for metastatic cancer, and receipt of expected standard-of-care treatment are reported. Significant sociodemographic disparities in access to equitable oncologic care exist along the continuum of pancreatic cancer care. Multiple patient, provider, and systemic factors contribute to these disparities. The ongoing study of these disparities is important to elucidate processes that may be targeted to improve access to equitable oncologic care for patients with pancreatic cancer.

Total Neoadjuvant Therapy Followed by Surgical Resection: Could it Be the New Standard of Care in Pancreatic Cancer? A Systematic Review

Introduction: Surgical resection with curative intent followed by adjuvant chemotherapy is still the standard of care in pancreatic cancer (PC). Neoadjuvant chemotherapy is more and more administered to borderline-resectable (BR) and locally advanced (LA) PC with achievement of higher percentage of resectability and improvement of oncological outcomes. Currently, total neoadjuvant therapy (TNT), intended as induction chemotherapy (IC) followed by radiochemotherapy (RCT), has been taking hold. Aim of this review is to summarize the available evidence on the role of TNT.

Pancreatic Cancer Care in the Era of COVID-19: Collateral Damage of the Pandemic

Introduction: COVID-19 has challenged healthcare in an unprecedented manner, requiring quarantines and shutdowns to mitigate virus spread. These restrictions may have inadvertently delayed treatment for oncologic diseases. This study aims to analyze the impact of COVID-19 delays on pancreatic cancer care at a quaternary-referral center. Methods: Fifty-six patients who underwent initial surgical resection of pancreatic neoplasms were retrospectively reviewed. The “COVID” group underwent surgery from March 1 – June 30, 2020, the period of limited hospital operations due to COVID-19. The “pre-COVID” control group included patients from the equivalent period in 2019. Time intervals between important clinical milestones and pathologic stage at resection were compared. Results: During the COVID shutdown, the time interval between almost every step in the care pathway was increased. Despite these clinically relevant differences, the only statistically significant difference was found for the time from presentation to pathological diagnosis with an increase of 14 days (p-value = 0.036). With regards to tumor stage, a 14.7% increase in patients presenting with stage III and IV cancer was found in 2020 compared to 2019, however, this difference did not reach statistical significance, likely related to limited sample size. Conclusion: COVID-19 has caused delays throughout the oncologic care pathway, which may have led to more advanced disease at the time of diagnosis. The impact of these delays on patient outcomes requires ongoing investigation to better characterize the collateral damage of COVID-19. To prevent further harm, healthcare systems need to prioritize oncologic patients while the pandemic persists.Tabled 1EP02D-019 Table 1. Time IntervalsInterval in Oncological Care PathwayTime During “Pre-COVID” (median days [IQR])Time During “COVID” (medians days [IQR])P-ValueSymptom Onset → Presentation12 [4.5 - 30.5]20.5 [1.5 - 74.2 ]0.425Presentation → Imaging Diagnosis1 [0 - 6.2]2.5 [0 - 27.2 ]0.414Presentation → Pathological Diagnosis7 [3 - 22]22 [8.2 - 35.8]0.036Presentation → Tumor Board58 [13 - 124]50 [35.8 - 71.8]0.807Pathological Diagnosis → 1st Treatment (Neoadjuvant + Surgical Resection)16.5 [11 - 39.2]20 [7 - 36.8]0.816Pathological Diagnosis → Neoadjuvant17 [16 - 39]25 [14 - 35.2]0.923Pathological Diagnosis → Surgical Resection49 [14 - 126]28.5 [7 - 107]0.663 Open table in a new tab

The Impact of Care Fragmentation on Pancreatic Cancer Care: More Complex Than It Seems

Introduction: Fragmentation of care (FC)—care at >1 facility—has been associated with increased cost, delayed treatment, and worse survival for gastrointestinal cancers. We assessed the impact of FC on pancreatic cancer care in California. Methods: Using the California Cancer Registry, linked with ambulatory surgery, emergency visits and discharge records from the Office of Statewide Health Planning Database, patients diagnosed with non-metastatic pancreatic ductal adenocarcinoma (PDAC) from 2007-2017 were identified. FC was determined by the number of unique facilities where patients received cancer care over the initial 12 months. We evaluated the association between FC and all-cause mortality using multivariable-adjusted Cox regression. Results: Among 9,464 PDAC patients, 4,545 patients received care at 1 facility (48.0%), 3,571 (37.7%) at 2, and 1,348 (14.2%) at >3. After adjusting for patient, tumor and hospital characteristics, female sex (HR=0.93 [0.89-0.97], p=0.001), high socioeconomic status (highest vs lowest quintile: HR=0.75 [0.70-0.82], p=<0.001) and cancer-hospital designations (all HR<1, p<0.001; see table) were associated with lower mortality. Mortality was lower for patients treated at 2 facilities compared to those treated at 1 facility (HR=0.95 [0.90-0.99], p=0.02), but was similar for patients treated at >3 vs 1 facility (HR=1.01 [0.94-1.07], p=0.87). Conclusions: Although prior data suggested that FC at >1 facility compromised cancer outcomes, in this large population-based cohort, PDAC patients treated at 2 facilities had better survival. FC is more complex than previously hypothesized. Our ongoing research is directed at better understanding “positive fragmentation” (e.g., seeking higher level of care) versus disjointed care (previously ascribed to fragmentation).

Abstract P071: Gemcitabine augments HLA class I expression in pancreatic cancer cells through alterations in transcript production and surface stability

Abstract Background: Pancreatic adenocarcinoma, or PDAC, is the fourth leading cause of cancer-related deaths in the United States. Gemcitabine, a nucleoside analog, is a primary standard of care in pancreatic cancer. In addition to its normative cytotoxic function, evidence suggests that this chemotherapy drug also harnesses immunomodulatory capabilities in the form of increasing human leukocyte antigen (HLA) class I expression in lung, breast, colon, and cholangiocarcinoma cells. HLA class I is a complex (alpha heavy chain and beta 2-microglobulin light chain) located at the surface of nearly all cells where it presents peptides, including cancer-associated peptides, to cytotoxic T cells. Recognition of these peptides as atypical leads to T-cell mediated lysis of the presenting cell. Subsequently, understanding the ability of gemcitabine and the mechanisms by which it influences the HLA class I complex are of great importance. Methods: To investigate the effect of gemcitabine treatment on HLA class I expression in pancreatic cancer, alterations in HLA class I protein levels were monitored via western blot analysis, flow cytometry, and quantitative polymerase chain reaction (qPCR) in three pancreatic cancer cell lines. Changes in surface stability of the HLA class I complex were evaluated through brefeldin A (BFA) assays at the 72-hour time point. For western blot and flow cytometry experiments, impacts on the alpha heavy chain were further assessed for all three types of alpha heavy chains (HLA-A, HLA-B/C) at 72 and 96 hours. In qPCR experiments, alterations were analyzed for the HLA-A, HLA-B, and beta 2-microglobulin transcripts after a 48-hour gemcitabine exposure period. Results: Administration of gemcitabine to pancreatic cancer cell lines (S2-013, Capan-1, PANC-1) increased total protein levels of both HLA class I constituents (alpha heavy chain and beta-2-microglobulin light chain). All PDAC cell lines evaluated demonstrated enhanced surface expression of HLA-A2 and HLA-B/C with maximal increases of 3 and 2.5-fold respectively, as indicated by flow cytometry. Our qPCR analysis of the Capan-1 and S2-013 cell lines revealed increases in the levels of HLA-A, HLA-B, and beta 2-microglobulin transcripts (3-12-fold). BFA assays suggested that gemcitabine treatment also enhances stability of the surface HLA class I in the S2-013 and PANC-1 cell lines. Conclusion: In summary, gemcitabine exhibits an immunomodulatory ability to stimulate expression of HLA class I in pancreatic cancer cells. We have demonstrated that this increase in HLA class I is seen at the mRNA, total protein, surface, and stability level. Characterizing the ability of gemcitabine to influence the HLA class I complex and defining the mechanisms by which it does so will increase the potential for identification of suitable immunotherapies, including novel peptide-based cancer vaccines with enhanced treatment efficacy for PDAC patients. Citation Format: Alaina C. Larson, Shelby M. Knoche, Joyce C. Solheim. Gemcitabine augments HLA class I expression in pancreatic cancer cells through alterations in transcript production and surface stability [abstract]. In: Abstracts: AACR Virtual Special Conference: Tumor Immunology and Immunotherapy; 2021 Oct 5-6. Philadelphia (PA): AACR; Cancer Immunol Res 2022;10(1 Suppl):Abstract nr P071.

Fragmentation of Care in Pancreatic Cancer: Effects on Receipt of Care and Survival

Introduction: Fragmented care (FC) has been associated with inferior cancer care and decreased survival. However, the impact of FC on pancreatic adenocarcinoma (PDAC) treatment remains unknown. The objective of this study was to evaluate factors associated with FC and its effect on PDAC treatment and survival.

Defining Operative Thresholds for High-Volume Pancreaticoduodenectomy Centers to Improve Surgical Outcomes

Background: Performance of pancreaticoduodenectomy at high-volume (HV) hospitals has been shown to reduce operative mortality. However, what threshold of case volume meaningfully impacts surgical outcomes is unknown. We determined a clinically meaningful cut-point for defining HV pancreaticoduodenectomy centers and assessed the impact of hospital volume on surgical outcomes. Methods: We identified adult NCDB patients undergoing pancreaticoduodenectomy between 2004-2015. A multivariable model with restricted cubic splines was built to predict 5-year overall survival according to average yearly case volume, adjusting for demographic/clinicopathologic factors. This data was then analyzed using a change-point procedure which identified two regression lines and a distinct segmentation at 24.6 cases/year. Hospitals were subsequently divided into HV (>/=25 cases/year) and low-volume (LV, <25 cases/year) groups. Chi-square tests were used to analyze group differences. Logistic regression was utilized to assess the impact of hospital volume on surgical outcomes. Results: Our cohort consisted of 32,333 patients (13.2% treated at HV centers). Treatment at a HV center was associated with increased likelihood of R0 resection and adequate lymph node evaluation. HV centers also had significantly decreased 30- and 90-day postoperative mortality (OR 0.34, 95% CI 0.25-0.46 and OR 0.48, 95% CI 0.40-0.58; respectively) after adjusting for age, sex, race, comorbidities, histology, and stage. Conclusion: Treatment at a HV pancreaticoduodenectomy center is associated with significantly improved surgical outcomes. Our study identified 25 cases/year as a clinically meaningful distinction between HV and LV centers which should be considered when evaluating regionalization of pancreatic cancer care to improve patient outcomes.

An Internal Review of Rates of Palliative Medicine Referral for Patients With Advanced Pancreatic Cancer.

BackgroundThe American Society of Clinical Oncology recommends that patients with advanced cancer receive palliative care services in concurrence with active treatment. While the benefits of palliative care are clear, integration of palliative care can be challenging. We aim to review rates of palliative care consultation in patients with advanced pancreatic cancer at our institution, intending to improve these rates.MethodsWe retrospectively reviewed the electronic records of all patients with pancreatic cancer treated at Allegheny General Hospital diagnosed between 2009-2020. Summary statistics are presented as percentages for categorical data and median with interquartile range for quantitative data.ResultsOf the 171 patients reviewed, 121 completed all treatment and evaluation within our health network (Pittsburgh, United States). The median age was 63 years (IQR 40-91 years); 55 patients (45%) were male; the majority were white (107 patients, 88%). At the time of diagnosis, 28% of our patients had stage IV disease (34 patients), and 19.8% of patients who developed stage IV disease had palliative care referrals.ConclusionsPalliative care is an integral part of usual care for advanced pancreatic cancer. Our analysis showed that palliative care is underutilized in our hospital. We aim to improve palliative care integration in our patients’ care by adding a hard stop to electronic medical records to remind physicians to offer palliative care to our patients with pancreatic cancer and to arrange lecture series to emphasize the importance of palliative care in this setting.

Preoperative Endoscopic Ultrasound Fine Needle Aspiration Versus Upfront Surgery in Resectable Pancreatic Cancer: A Systematic Review and Meta-analysis of Clinical Outcomes Including Survival and Risk of Tumor Recurrence.

Background and AimEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the standard of care in advanced pancreatic cancer. Its role in resectable disease, however, is controversial. This meta-analysis aims to ascertain the clinical outcomes of patients with resectable pancreatic cancer undergoing preoperative EUS-FNA compared to those going directly to surgery.MethodsA literature search was performed from 1996 to April 2019 using MEDLINE, EMBASE, and ISI Web of Knowledge for studies comparing preoperative EUS-FNA to EUS without FNA in resectable pancreatic cancer for clinical outcomes. The primary outcome is overall survival (OS). Secondary outcomes include cancer-free survival, tumor recurrence and peritoneal carcinomatosis, and post-FNA-pancreatitis rate.ResultsSix retrospective studies were included. Preoperative EUS-FNA had better OS than the non-FNA group (WMD, 4.40 months [0.02 to 8.78]). Cancer-free survival did not differ significantly between the two groups (WMD, 2.08 months [−2.22 to 6.38]). EUS with FNA was not associated with increased rates of tumor recurrence or peritoneal carcinomatosis.ConclusionPreoperative EUS-FNA in resectable pancreatic cancer may be associated with significantly greater OS when compared to the non-FNA group, with no significant difference in the rates of tumor recurrence or peritoneal seeding. Important limitations of our meta-analysis include the lack of prospective controlled data, which are unlikely to emerge given feasible constraints.