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Rodríguez-Gómez M, Pastor-Moreno G, Ruiz-Pérez I, Escribà-Agüir V, Benítez-Hidalgo V. Age- and gender-based social inequalities in palliative care for cancer patients: a systematic literature review. Front Public Health 2024; 12:1421940. [PMID: 39296836 PMCID: PMC11408182 DOI: 10.3389/fpubh.2024.1421940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/16/2024] [Indexed: 09/21/2024] Open
Abstract
Objectives Cancer is a major public health problem worldwide, given its magnitude and growing burden, in addition to the repercussions on health and quality of life. Palliative care can play an important role improving quality of life and it is cost-effective, but some population groups may not benefit from it or benefit less based on age and gender inequalities. The aim of this systematic review was to analyze the available evidence on age- and gender-based social inequalities in access to and use of palliative care in cancer patients. Methods A systematic review was conducted following the PRISMA guidelines. An exhaustive literature research was performed in Pubmed, CINHAL and Embase until November 2022 and were not restricted by language or date of publication. Eligible studies were observational studies analyzing the access and use of palliative care in cancer patients. Results Fifty-three studies were included in the review. Forty-five analyzed age and 44 analyzed gender inequalities in relation to use of and access to palliative care. Our results show that older people receive poorer quality of care, worst symptom control and less preferences for palliative care. In relation to gender, women have a greater preference for the use of palliative care and generally have more access to basic and specialized palliative care services and palliative care facilities. Conclusion This review reveals difficulties for older persons and men for access to key elements of palliative care and highlights the need to tackle access barriers for the most vulnerable population groups. Innovative collaborative services based around patient, family and wider community are needed to ensure optimal care.
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Affiliation(s)
| | - Guadalupe Pastor-Moreno
- Andalusian School of Public Health (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada. Ibs. GRANADA, Granada, Spain
| | - Isabel Ruiz-Pérez
- Andalusian School of Public Health (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada. Ibs. GRANADA, Granada, Spain
| | - Vicenta Escribà-Agüir
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
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2
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Eaglehouse YL, Darmon S, Gage MM, Shriver CD, Zhu K. Characteristics Associated With Survival in Surgically Nonresected Pancreatic Adenocarcinoma in the Military Health System. Am J Clin Oncol 2024; 47:64-70. [PMID: 37851358 PMCID: PMC10805355 DOI: 10.1097/coc.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Pancreatic cancer is often diagnosed at advanced stages with high-case fatality. Many tumors are not surgically resectable. We aimed to identify features associated with survival in patients with surgically nonresected pancreatic cancer in the Military Health System. METHODS We used the Military Cancer Epidemiology database to identify the Department of Defense beneficiaries aged 18 and older diagnosed with a primary pancreatic adenocarcinoma between January 1998 and December 2014 who did not receive oncologic surgery as treatment. We used Cox Proportional Hazard regression with stepwise procedures to select the sociodemographic and clinical characteristics related to 2-year overall survival, expressed as adjusted hazard ratios (aHR) and 95% CIs. RESULTS Among 1148 patients with surgically nonresected pancreatic cancer, sex, race-ethnicity, marital status, and socioeconomic indicators were not selected in association with survival. A higher comorbidity count (aHR 1.30, 95% CI: 1.06-1.59 for 5 vs. 0), jaundice at diagnosis (aHR 1.57, 95% CI: 1.33-1.85 vs. no), tumor grade G3 or G4 (aHR 1.32, 95% CI: 1.05-1.67 vs. G1/G2), tumor location in pancreas tail (aHR 1.49, 95% CI: 1.22-1.83 vs. head) or body (aHR 1.30, 95% CI: 1.04-1.62 vs. head), and metastases were associated with survival. Patients receiving chemotherapy (aHR 0.66, 95% CI: 0.57-0.76) had better survival compared with no treatment. CONCLUSIONS In a comprehensive health system, sociodemographic characteristics were not related to survival in surgically nonresected pancreatic cancer. This implicates access to care in reducing survival disparities in advanced pancreatic cancer and emphasizes the importance of treating patients based on clinical features.
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Affiliation(s)
- Yvonne L. Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
| | - Sarah Darmon
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
| | - Michele M. Gage
- Departments of Surgery
- Division of Surgical Oncology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Craig D. Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- Departments of Surgery
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
- Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences
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3
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Huynh TNT, Hartel G, Janda M, Wyld D, Merrett N, Gooden H, Neale RE, Beesley VL. The Unmet Needs of Pancreatic Cancer Carers Are Associated with Anxiety and Depression in Patients and Carers. Cancers (Basel) 2023; 15:5307. [PMID: 38001567 PMCID: PMC10670364 DOI: 10.3390/cancers15225307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Pancreatic cancer has one of the lowest survival rates, and patients experience debilitating symptoms. Family carers provide essential daily care. This study determined the prevalence of and risk factors for unmet supportive care needs among carers for pancreatic cancer patients and examined which carer needs were associated with anxiety and depression in carers and patients. Eighty-four pancreatic cancer patients and their carers were recruited. The carers completed a needs survey (SCNS-P&C). Both carers and patients completed the Hospital Anxiety and Depression Scale. Log binomial regression was used to identify associations between carer needs and anxiety and depression among carers and patients. The top 10 moderate-to-high unmet needs reported by ≥28% of carers were related to healthcare (e.g., discussing concerns with doctors) and information need domains (e.g., information about a patient's physical needs), plus one other item related to hospital parking. Being male or caring for a patient within 4 months of their diagnosis were associated with greater unmet needs. Some unmet needs, including 'accessing information about treatments' and 'being involved in patient care', were associated with both carers and patients having anxiety and depression. Carers should be involved in health care consultations and provided with information and opportunities to discuss concerns.
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Affiliation(s)
- Thi N. T. Huynh
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.N.T.H.); (G.H.); (R.E.N.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
| | - Gunter Hartel
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.N.T.H.); (G.H.); (R.E.N.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Monika Janda
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
| | - David Wyld
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
| | - Neil Merrett
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia;
| | - Helen Gooden
- School of Nursing and Midwifery, University of Sydney, Sydney, NSW 2006, Australia;
| | - Rachel E. Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.N.T.H.); (G.H.); (R.E.N.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
| | - Vanessa L. Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; (T.N.T.H.); (G.H.); (R.E.N.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; (M.J.); (D.W.)
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
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4
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Bai LY, Li CP, Shan YS, Chuang SC, Chen JS, Chiang NJ, Chen YY, Tsou HH, Chuang MH, Chiu CF, Liu TW, Chen LT. A prospective phase II study of biweekly S-1, leucovorin, and gemcitabine in elderly patients with locally advanced or metastatic pancreatic adenocarcinoma - The Taiwan Cooperative Oncology Group T1217 study. Eur J Cancer 2022; 173:123-132. [PMID: 35932625 DOI: 10.1016/j.ejca.2022.06.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Elderly patients with advanced pancreatic adenocarcinoma (APC) are conceived to be frailer and susceptible to treatment toxicity that has led to disparity in lower likelihood of receiving chemotherapy and survival. Optimal chemotherapy is an unmet medical need for elderly patients with APC. PATIENTS AND METHODS Patients with chemo-naive APC, age ≥70 years, and Eastern Cooperative Oncology Group (ECOG) performance score ≤2 were eligible. The treatment was consisted of biweekly gemcitabine 800 mg/m2, 10 mg/m2/min infusion on day 1 plus oral S-1 and leucovorin (40-60 and 30 mg, respectively) twice daily on days 1-7, the GSL regimen. The primary end-point was progression-free survival with an interested P1 of 5.0 months. RESULTS Of the 49 enrolled patients, the median age was 76 years, ECOG performance score ≥1 in 59.2%, metastatic diseases in 65.3%, Vulnerable Elders Survey-13 score ≥3 in 71.4%, and Geriatric 8 score ≤14 in 93.9%. After a median 11 cycles of treatment, the overall response rate and disease control rate were 26.5% and 75.5%, respectively. The median progression-free and overall survivals were 6.6 months (95% confidence interval [CI], 5.4-9.2) and 12.5 months (95% CI, 8.9-14.7), respectively. The most common grade 3-4 treatment-related toxicities were anaemia (20.4%), neutropenia (18.4%), and mucositis (12.2%). Patients had improved emotional function and global health status scores during the GSL treatment. CONCLUSION The study met its primary end-point, which supports further investigation on the merit of GSL in Asian elderly APC patients.
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Affiliation(s)
- Li-Yuan Bai
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, 40402 Taiwan; College of Medicine, School of Medicine, China Medical University, Taichung, 40402 Taiwan
| | - Chung-Pin Li
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yan-Shen Shan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Shih-Chang Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Surgery, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Nai-Jung Chiang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Yen-Yang Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan
| | - Hsiao-Hui Tsou
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
| | - Mei-Hsing Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chang-Fang Chiu
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, 40402 Taiwan; College of Medicine, School of Medicine, China Medical University, Taichung, 40402 Taiwan; Cancer Center, China Medical University Hospital, Taichung, 40402 Taiwan
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Li-Tzong Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan; Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Center of Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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5
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Logan K, Pearson F, Kenny RP, Pandanaboyana S, Sharp L. Are older patients less likely to be treated for pancreatic cancer? A systematic review and meta-analysis. Cancer Epidemiol 2022; 80:102215. [PMID: 35901624 DOI: 10.1016/j.canep.2022.102215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022]
Abstract
Pancreatic cancer is the seventh commonest cause of cancer-related death worldwide. Although prognosis is poor, both surgery and adjuvant chemotherapy improve survival. However, it has been suggested that not all pancreatic cancer patients who may benefit from treatment receive it. This systematic review and meta-analysis investigated the existence of age-related inequalities in receipt of first-line pancreatic cancer treatment. Medline, Embase, Cochrane Library and grey literature were searched for population-based studies investigating treatment receipt, reported by age, for patients with primary pancreatic cancer from inception until 4th June 2020, and updated 5th August 2021. Studies from countries with universal healthcare were included, to minimise influence of health system-related economic factors. A modified version of the Newcastle-Ottawa Scale was used to assess risk of bias. Random-effects meta-analysis was undertaken comparing likelihood of treatment receipt in older versus younger patients. Sensitivity and subgroup analyses were conducted. Eighteen papers were included; 12 independent populations were eligible for meta-analysis. In most studies, < 10% of older patients were treated. Older age (generally ≥65) was significantly associated with reduced receipt of any treatment (OR=0.14, 95% CI 0.10-0.21, n = 12 studies), surgery (OR=0.15, 95% CI 0.09-0.24, n = 9 studies) and chemotherapy as a primary treatment (OR=0.13, 95% CI 0.07-0.24, n = 5 studies). The effect of age was independent of methodological quality, patient population or time-period of patient diagnosis and remained in studies with confounder adjustment. The mean quality score of included studies was 6/8. Inequalities in receipt of healthcare interventions across social groups is a recognised concern internationally. This review shows that older age is significantly, and consistently, associated with non-receipt of treatment in pancreatic cancer. However, there are risks and side-effects associated with pancreatic cancer treatment. Further research on what influences patient and professional treatment decision-making is required to better understand these apparent inequalities.
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Affiliation(s)
- Kirsty Logan
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Fiona Pearson
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Ryan Pw Kenny
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Sanjay Pandanaboyana
- Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom; HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom.
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6
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Pijnappel EN, Dijksterhuis WPM, Sprangers MAG, Augustinus S, de Vos-Geelen J, de Hingh IHJT, Molenaar IQ, Busch OR, Besselink MG, Wilmink JW, van Laarhoven HWM. The fear of cancer recurrence and progression in patients with pancreatic cancer. Support Care Cancer 2022; 30:4879-4887. [PMID: 35169873 PMCID: PMC9046341 DOI: 10.1007/s00520-022-06887-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE It is plausible that patients with pancreatic cancer experience fear of tumor recurrence or progression (FOP). The aim of this study was to compare FOP in patients with pancreatic cancer treated with surgical resection, palliative systemic treatment, or best supportive care (BSC) and analyze the association between quality of life (QoL) and FOP and the effect of FOP on overall survival (OS). METHODS This study included patients diagnosed with pancreatic cancer between 2015 and 2018, who participated in the Dutch Pancreatic Cancer Project (PACAP). The association between QoL and WOPS was assessed with logistic regression analyses. OS was evaluated using Kaplan-Meier curves with the log-rank tests and multivariable Cox proportional hazard analyses adjusted for clinical covariates and QoL. RESULTS Of 315 included patients, 111 patients underwent surgical resection, 138 received palliative systemic treatment, and 66 received BSC. Patients who underwent surgical resection had significantly lower WOPS scores (i.e., less FOP) at initial diagnosis compared to patients who received palliative systemic treatment or BSC only (P < 0.001). Better QoL was independently associated with the probability of having a low FOP in the BSC (OR 0.95, 95% CI 0.91-0.98) but not in the surgical resection (OR 0.97, 95% CI 0.94-1.01) and palliative systemic treatment groups (OR 0.97, 95% CI 0.94-1.00). The baseline WOPS score was not independently associated with OS in any of the subgroups. CONCLUSION Given the distress that FOP evokes, FOP should be explicitly addressed by health care providers when guiding pancreatic cancer patients through their treatment trajectory, especially those receiving palliative treatment or BSC.
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Affiliation(s)
- Esther N Pijnappel
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Willemieke P M Dijksterhuis
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, Utrecht, 3501 DB, The Netherlands
| | - Mirjam A G Sprangers
- Department of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone Augustinus
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW-School for Oncology and Developmental Biology, Maastricht UMC+, P. Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | | | - Izaak Q Molenaar
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Johanna W Wilmink
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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7
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Torres MB, Dixon MEB, Gusani NJ. Undertreatment of Pancreatic Cancer: The Intersection of Bias, Biology, and Geography. Surg Oncol Clin N Am 2021; 31:43-54. [PMID: 34776063 DOI: 10.1016/j.soc.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Pancreatic cancer is the third leading cause of cancer deaths in the United States. Black patients with pancreatic cancer experience higher incidence and increased mortality. Although racial biologic differences exist, socioeconomic status, insurance type, physician bias, and patient beliefs contribute to the disparities in outcomes observed among patients who are Black, indigenous, and people of color.
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Affiliation(s)
- Madeline B Torres
- General Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Avenue MC H149, Hershey, PA 17033, USA. https://twitter.com/MadelineBTorres
| | - Matthew E B Dixon
- Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, 500 University Avenue MC H070, Hershey, PA 17036, USA. https://twitter.com/mebdixon
| | - Niraj J Gusani
- Section of Surgical Oncology, Baptist MD Anderson Cancer Center, 1301 Palm Avenue, Jacksonville, FL 32207, USA.
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8
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Papageorge MV, Evans DB, Tseng JF. Health Care Disparities and the Future of Pancreatic Cancer Care. Surg Oncol Clin N Am 2021; 30:759-771. [PMID: 34511195 DOI: 10.1016/j.soc.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There have been tremendous advances in the diagnosis and treatment of pancreatic cancer in the past decade, yet we are failing to achieve equitable outcomes for all patient populations. Disparities exist in the incidence, diagnosis, treatment, and outcomes of patients with pancreatic cancer. Inequities are based on racial and ethnic group, sex, socioeconomic status, and geography. To address disparities, future steps must focus on research methods, including collection and methodology, and policy measures, including access, patient tools, hospital incentives, and workforce diversity. Through these comprehensive efforts, we can begin to rectify inequitable care for treatment of patients with pancreatic cancer.
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Affiliation(s)
- Marianna V Papageorge
- Boston Medical Center, Boston University School of Medicine, 88 East Newton Street, Collamore - C500, Boston, MA 02118, USA. https://twitter.com/MPapageorge_MD
| | - Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Wilwaukee, WI 53226, USA. https://twitter.com/@DougEvans2273
| | - Jennifer F Tseng
- Boston Medical Center, Boston University School of Medicine, 88 East Newton Street, Collamore - C500, Boston, MA 02118, USA.
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9
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Yee EK, Coburn NG, Zuk V, Davis LE, Mahar AL, Liu Y, Gupta V, Darling G, Hallet J. Geographic impact on access to care and survival for non-curative esophagogastric cancer: a population-based study. Gastric Cancer 2021; 24:790-799. [PMID: 33550518 DOI: 10.1007/s10120-021-01157-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Among patients not undergoing curative-intent therapy for esophagogastric cancer, access to care may vary. We examined the geographic distribution of care delivery and survival and their relationship with distance to cancer centres for non-curative esophagogastric cancer, hypothesising that patients living further from cancer centres have worse outcomes. METHODS We conducted a population-based analysis of adults with non-curative esophagogastric cancer from 2005 to 2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival. Using geographic information system analysis, we mapped locations of cancer centres and outcomes across census divisions. Bivariate choropleth maps identified regional outcome discordances. Multivariable regression models assessed the relationship between distance from patient residence to the nearest cancer centre and outcomes, adjusting for demographic, clinical, and socioeconomic factors. RESULTS Of 10,228 patients surviving a median 5.1 months (IQR: 2.0-12.0), 68.5% had medical oncology consultation and 32.2% received chemotherapy. Certain distances (reference ≤ 10 km) were associated with lower consultation [relative risk 0.79 (95% CI 0.63-0.97) for ≥ 101 km], chemotherapy receipt [relative risk 0.67 (95% CI 0.53-0.85) for ≥ 101 km], and overall survival [hazard ratio 1.07 (95% CI 1.02-1.13) for 11-50 km, hazard ratio 1.13 (95% CI 1.04-1.23) for 51-100 km]. CONCLUSION A third of patients did not see medical oncology and most did not receive chemotherapy. Outcomes exhibited high geographic variability. Location of residence influenced outcomes, with inferior outcomes at certain distances > 10 km from cancer centres. These findings are important for designing interventions to reduce access disparities for non-curative esophagogastric cancer care.
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Affiliation(s)
- Elliott K Yee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Natalie G Coburn
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Victoria Zuk
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Laura E Davis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ying Liu
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Vaibhav Gupta
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Gail Darling
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Toronto General Hospital Research Institute, Toronto General Hospital, Toronto, ON, Canada
| | - Julie Hallet
- Cancer Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. .,Department of Surgery, University of Toronto, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada.
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10
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Choi CCM, Choi J, Houli N, Smith M, Usatoff V, Lipton L, Chan S. Evaluation of palliative treatments in unresectable pancreatic cancer. ANZ J Surg 2021; 91:915-920. [PMID: 33870626 DOI: 10.1111/ans.16669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) presents as unresectable disease in 80% of patients. Limited Australian data exists regarding management and outcome of palliative management for PDAC. This study aims to: (i) identify patients with PDAC being managed with palliative intent; (ii) assess the type of palliative management being used. METHODS A prospectively maintained pancreatic database at Western Health (2015-2017) was used to identify patient demographics; stage and multidisciplinary decision regarding resectability and operative interventions; palliative care; use of chemotherapy, radiotherapy and; management of exocrine and endocrine insufficiency. Data on chemotherapy use, number of hospital admissions, emergency department attendances and intensive care unit admissions 30 days prior to death were recorded. RESULTS One-hundred and eleven patients had diagnosis of PDAC, 15% with locally advanced and 45% with metastatic PDAC. Among the locally advanced and metastatic PDAC, 48% received biliary stent insertions, 93% had palliative care referral, 45% received palliative chemotherapy and 10% received radiotherapy. Dietitian referral occurred in 79% and 36% were prescribed with a pancreatic enzyme replacement therapy. Diabetes mellitus was present in 52% of which 31% was new onset. Within 30 days prior to death, 11% patients received palliative chemotherapy, 32% were hospitalized and 11% visited an emergency department more than once. Sixty-five percent died in hospital. CONCLUSION A high proportion of patients diagnosed with locally advanced and metastatic PDAC received palliative care referrals and appropriate level of end-of-life care. Further prospective studies are necessary, examining the management and impacts of pancreatic insufficiency in this group.
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Affiliation(s)
- Colin Chan-Min Choi
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia
| | - Julian Choi
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Western Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nezor Houli
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia
| | - Marty Smith
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia
| | - Val Usatoff
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Western Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lara Lipton
- Department of Oncology, Western Health, Melbourne, Victoria, Australia
| | - Steven Chan
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Western Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
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11
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Yee EK, Coburn NG, Davis LE, Mahar AL, Zuk V, Gupta V, Liu Y, Earle CC, Hallet J. Impact of Geography on Care Delivery and Survival for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis. J Natl Compr Canc Netw 2020; 18:1642-1650. [PMID: 33285520 DOI: 10.6004/jnccn.2020.7605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about how the geographic distribution of cancer services may influence disparities in outcomes for noncurable pancreatic adenocarcinoma. We therefore examined the geographic distribution of outcomes for this disease in relation to distance to cancer centers. METHODS We conducted a retrospective population-based analysis of adults in Ontario, Canada, diagnosed with noncurable pancreatic adenocarcinoma from 2004 through 2017 using linked administrative healthcare datasets. The exposure was distance from place of residence to the nearest cancer center providing medical oncology assessment and systemic therapy. Outcomes were medical oncology consultation, receipt of cancer-directed therapy, and overall survival. We examined the relationship between distance and outcomes using adjusted multivariable regression models. RESULTS Of 15,970 patients surviving a median of 3.3 months, 65.6% consulted medical oncology and 38.5% received systemic therapy. Regions with comparable outcomes were clustered throughout Ontario. Mapping revealed regional discordances between outcomes. Increasing distance (reference, ≤10 km) was independently associated with lower likelihood of medical oncology consultation (relative risks [95% CI] for 11-50, 51-100, and ≥101 km were 0.90 [0.83-0.98], 0.78 [0.62-0.99], and 0.77 [0.55-1.08], respectively) and worse survival (hazard ratios [95% CI] for 11-50, 51-100, and ≥101 km were 1.08 [1.04-1.12], 1.17 [1.10-1.25], and 1.10 [1.02-1.18], respectively), but not with likelihood of receiving therapy. Receipt of therapy seems less sensitive to distance, suggesting that distance limits entry into the cancer care system via oncology consultation. Regional outcome discordances suggest inefficiencies within and protective factors outside of the cancer care system. CONCLUSIONS These findings provide a basis for clinicians to optimize their practices for patients with noncurable pancreatic adenocarcinoma, for future studies investigating geographic barriers to care, and for regional interventions to improve access.
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Affiliation(s)
- Elliott K Yee
- 1Faculty of Medicine, University of Toronto, Toronto, Ontario.,2Cancer Program - Evaluative Clinical Sciences, and
| | - Natalie G Coburn
- 2Cancer Program - Evaluative Clinical Sciences, and.,3Department of Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario.,4Department of Surgery, University of Toronto, Toronto, Ontario.,5ICES, Toronto, Ontario
| | - Laura E Davis
- 6Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
| | - Alyson L Mahar
- 7Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba; and
| | - Victoria Zuk
- 2Cancer Program - Evaluative Clinical Sciences, and
| | - Vaibhav Gupta
- 2Cancer Program - Evaluative Clinical Sciences, and.,4Department of Surgery, University of Toronto, Toronto, Ontario
| | - Ying Liu
- 4Department of Surgery, University of Toronto, Toronto, Ontario
| | - Craig C Earle
- 2Cancer Program - Evaluative Clinical Sciences, and.,5ICES, Toronto, Ontario.,8Division of Medical Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- 2Cancer Program - Evaluative Clinical Sciences, and.,3Department of Surgery, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario.,4Department of Surgery, University of Toronto, Toronto, Ontario.,5ICES, Toronto, Ontario
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12
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Latenstein AEJ, Mackay TM, Creemers GJ, van Eijck CHJ, de Groot JWB, Haj Mohammad N, Homs MYV, van Laarhoven HWM, Molenaar IQ, ten Tije BJ, de Vos-Geelen J, Besselink MG, van der Geest LGM, Wilmink JW. Implementation of contemporary chemotherapy for patients with metastatic pancreatic ductal adenocarcinoma: a population-based analysis. Acta Oncol 2020; 59:705-712. [PMID: 32056483 DOI: 10.1080/0284186x.2020.1725241] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Positive results of randomized trials led to the introduction of FOLFIRINOX in 2012 and gemcitabine with nab-paclitaxel in 2015 for patients with metastatic pancreatic ductal adenocarcinoma. It is unknown to which extent these new chemotherapeutic regimens have been implemented in clinical practice and what the impact has been on overall survival.Material and methods: Patients diagnosed with metastatic pancreatic ductal adenocarcinoma between 2007-2016 were included from the population-based Netherlands Cancer Registry. Multilevel logistic regression and Cox regression analyses, adjusting for patient, tumor, and hospital characteristics, were used to analyze variation of chemotherapy use.Results: In total, 8726 patients were included. The use of chemotherapy increased from 31% in 2007-2011 to 37% in 2012-2016 (p < .001). Variation in the use of any chemotherapy between centers decreased (adjusted range 2007-2011: 12-67%, 2012-2016: 20-54%) whereas overall survival increased from 5.6 months to 6.4 months (p < .001) for patients treated with chemotherapy. Use of FOLFIRINOX and gemcitabine with nab-paclitaxel varied widely in 2015-2016, but both showed a more favorable overall survival compared to gemcitabine monotherapy (median 8.0 vs. 7.0 vs. 3.8 months, respectively). In the period 2015-2016, FOLFIRINOX was used in 60%, gemcitabine with nab-paclitaxel in 9.7% and gemcitabine monotherapy in 25% of patients receiving chemotherapy.Conclusion: Nationwide variation in the use of chemotherapy decreased after the implementation of FOLFIRINOX and gemcitabine with nab-paclitaxel. Still a considerable proportion of patients receives gemcitabine monotherapy. Overall survival did improve, but not clinically relevant. These results emphasize the need for a structured implementation of new chemotherapeutic regimens.
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Affiliation(s)
- Anouk E. J. Latenstein
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Tara M. Mackay
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands
| | | | | | | | - Nadia Haj Mohammad
- Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - I. Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, St Antonius Hospital Nieuwegein and University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | - Bert-Jan ten Tije
- Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | - Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc G. Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Lydia G. M. van der Geest
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Johanna W. Wilmink
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands
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13
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Barreto SG. Pancreatic cancer in Australia: is not it time we address the inequitable resource problem? Future Oncol 2020; 16:1385-1392. [PMID: 32412798 DOI: 10.2217/fon-2020-0109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The present study reviewed the geographical variations in the delivery of pancreatic cancer therapy and whether this impacts overall survival. The evidence suggests a difference in the accessibility of pancreatic cancer care to patients in rural as compared with urban Australia. While centralization of pancreatic surgery is essential to deliver high quality care to patients, it may be interfering with the ease of access of this form of care to patients in regional areas. Access to chemotherapy in regional Australia is also limited. There is need for a concerted effort to improve the overall care and uptake of medical services to patients in metropolitan and remote Australia with the overarching aim of improving survival and meaningful quality of life.
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Affiliation(s)
- Savio George Barreto
- Division of Surgery & Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.,College of Medicine & Public Health, Flinders University, South Australia, Australia
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14
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Mavros MN, Coburn NG, Davis LE, Mahar AL, Liu Y, Beyfuss K, Myrehaug S, Earle CC, Hallet J. Low rates of specialized cancer consultation and cancer-directed therapy for noncurable pancreatic adenocarcinoma: a population-based analysis. CMAJ 2020; 191:E574-E580. [PMID: 31133604 DOI: 10.1503/cmaj.190211] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Michail N Mavros
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Natalie G Coburn
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Laura E Davis
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Alyson L Mahar
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Ying Liu
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Kaitlyn Beyfuss
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Sten Myrehaug
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Craig C Earle
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Julie Hallet
- Department of Surgery (Mavros, Coburn, Hallet), University of Toronto; Divisions of General Surgery (Coburn, Hallet), Radiation Oncology (Myrehaug) and Medical Oncology (Earle), Odette Cancer Centre - Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Coburn, Davis, Beyfuss, Earle, Hallet); ICES (Coburn, Liu, Earle, Hallet), Toronto, Ont.; Department of Community Health Sciences (Mahar), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.
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15
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Bjerring OS, Fristrup CW, Pfeiffer P, Lundell L, Mortensen MB. Phase II randomized clinical trial of endosonography and PET/CT versus clinical assessment only for follow-up after surgery for upper gastrointestinal cancer (EUFURO study). Br J Surg 2019; 106:1761-1768. [DOI: 10.1002/bjs.11290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/25/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Upper gastrointestinal malignancies have a poor prognosis. There is no consensus on how patients should be followed after surgery. The authors hypothesized that a structured follow-up programme including endoscopic ultrasonography (EUS) and [18F]fluorodeoxyglucose (FDG) PET/CT would detect cancer recurrences, leading to more patients being eligible for therapy.
Methods
After surgery with curative intent for adenocarcinomas in the gastro-oesophageal junction, stomach or pancreas, patients were randomized 1 : 1 to standard clinical assessment in the outpatient clinic at 3, 6, 9, 12, 18 and 24 months after operation, or clinical assessment plus imaging including [18F]FDG PET/CT and EUS. The primary endpoint was number of patients receiving oncological treatment for recurrence. Secondary endpoints were overall and progression-free survival, survival after recurrence detection of isolated locoregional recurrences and risk factors affecting survival.
Results
In total, 183 patients were enrolled, including 93 who underwent standard follow-up and 90 who had follow-up plus imaging. A recurrence was detected in 84 patients within 2 years after surgery (42 in each group), including 33 of 42 patients in the imaging group who were asymptomatic. Some 25 of 42 patients in the imaging group and 14 of 42 in the standard group received chemotherapy (P = 0·028). Although survival after detection of recurrence in asymptomatic patients was significantly longer than that for symptomatic patients (P < 0·001), overall survival from date of surgery in the two treatment groups was comparable.
Conclusion
Follow-up after surgery for upper gastrointestinal cancer with EUS and PET/CT leads to detection of more asymptomatic cancer recurrences and patients referred for treatment without prolonging overall survival. Registration number: NCT02209415 (http://www.clinicaltrials.gov).
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Affiliation(s)
- O S Bjerring
- Upper Gastrointestinal and Hepatopancreatobiliary Section, Department of Surgery, Odense University Hospital, Odense, Denmark
- Odense Pancreas Centre, Odense University Hospital, Odense, Denmark
| | - C W Fristrup
- Upper Gastrointestinal and Hepatopancreatobiliary Section, Department of Surgery, Odense University Hospital, Odense, Denmark
- Odense Pancreas Centre, Odense University Hospital, Odense, Denmark
| | - P Pfeiffer
- Odense Pancreas Centre, Odense University Hospital, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - L Lundell
- Upper Gastrointestinal and Hepatopancreatobiliary Section, Department of Surgery, Odense University Hospital, Odense, Denmark
- Odense Pancreas Centre, Odense University Hospital, Odense, Denmark
- Department of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - M B Mortensen
- Upper Gastrointestinal and Hepatopancreatobiliary Section, Department of Surgery, Odense University Hospital, Odense, Denmark
- Odense Pancreas Centre, Odense University Hospital, Odense, Denmark
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