RT Journal Article
SR Electronic
T1 Low rates of specialized cancer consultation and cancer-directed therapy for noncurable pancreatic adenocarcinoma: a population-based analysis
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E574
OP E580
DO 10.1503/cmaj.190211
VO 191
IS 21
A1 Michail N. Mavros
A1 Natalie G. Coburn
A1 Laura E. Davis
A1 Alyson L. Mahar
A1 Ying Liu
A1 Kaitlyn Beyfuss
A1 Sten Myrehaug
A1 Craig C. Earle
A1 Julie Hallet
YR 2019
UL http://www.cmaj.ca/content/191/21/E574.abstract
AB BACKGROUND: Although advancements in systemic therapy have improved the outlook for pancreatic adenocarcinoma, it is not known if patients get access to these therapies. We aimed to examine the patterns and factors associated with access to specialized cancer consultations and subsequent receipt of cancer-directed therapy for patients with non-curative pancreatic adenocarcinoma.METHODS: We conducted a population-based analysis of noncurative pancreatic adenocarcinoma diagnosed over 2005–2016 in Ontario by linking administrative health care data sets. Our primary outcomes were specialized cancer consultation and receipt of cancer-directed therapy (chemotherapy or a combination of chemo- and radiation therapy [chemoradiation therapy]). We examined specialized cancer consultation with hepato-pancreatico-biliary surgery, medical and radiation oncology. We used multivariable logistic regression to identify factors associated with medical oncology consultation and cancer-directed therapy.RESULTS: Of 10 881 patients, 64.9% had a consultation with specialists in medical oncology, 35.1% with hepatopancreatico-biliary surgery and 24.7% with radiation oncology. Sociodemographic characteristics were not associated with the likelihood of medical oncology consultation. Of these patients, 4144 received cancer-directed therapy, representing 38.1% of all patients and 58.6% of those who consulted with medical oncology. Of 6737 patients not receiving cancer-directed therapy, 2988 (44.4%) had a consultation with medical oncology. Older age and lowest income quintile were independently associated with lower likelihood of cancer-directed therapy. If the first specialized cancer consultation was with medical or radiation oncology, the likelihood of cancer-directed therapy was significantly higher compared with surgery.INTERPRETATION: A considerable proportion of patients with noncurable pancreatic adenocarcinoma in Ontario did not have a specialized cancer consultation and most did not receive cancer-directed therapy. We identified disparities in specialized cancer consultation and receipt of systemic cancer-directed therapy that indicate potential gaps in assessment.