Advanced pancreatic adenocarcinoma outcomes with transition from devolved to centralised care in a regional Cancer Centre

Abstract

Background:Previous observations suggest suboptimal ‘real world' survival outcomes for advanced pancreatic adenocarcinoma. We hypothesized that centralisation of advanced pancreatic adenocarcinoma management would improve chemotherapy treatment and survival from the disease.Methods:The data was prospectively collected on all cases of advanced pancreatic adenocarcinoma reviewed through Clatterbridge Cancer Centre according to two groups; 1 October 2009–31st Dec 2010 (devolved care) or 1 January 2013–31 March 2014 (centralised care). Analysis included treatment received, 30-day chemotherapy mortality rate and overall survival (OS).Results:More patients received chemotherapy with central care (67.0% (n=115) vs 43.0% (n=121); P=2.2 × 10−4) with no difference in 30-day mortality (20.8% vs 25% P=0.573) but reduced time to commencement of chemotherapy (18 vs 28 days, P=1.0 × 10−3). More patients received second-line chemotherapy with central care (23.4% vs 1.9%, P=1.4 × 10−4), while OS was significantly increased with central care (median: Five vs three months, HR 0.785, P=0.045). Exploratory analysis suggested that it was those with a poorer performance status, elderly or with metastatic disease who benefited the most from transition to central care.Conclusions:A centralised clinic model for advanced pancreatic cancer management resulted in prompt, safe and higher use of chemotherapy compared with devolved care. This was associated with a modest survival benefit. Prospective studies are required to validate the findings reported and the basis for improved survival with centralised care.

Nonsurgical therapies for resected and unresected pancreatic cancer in Europe and USA in 2003–2014: a large international population‐based study

“…The strongest increase was observed in the Netherlands, where reimbursement for gemcitabine was possible since November 2008, 28 with utilization rates increasing from 10 (2003-2005) to 56% (2012-2014) among resected patients. The observed trends and variations might also be associated with centralization and/or specialization of PaC management, 29 and academic hospital was associated with more frequent use of adjuvant chemotherapy. In the Netherlands, all hospitals are eligible to prescribe the chemotherapeutic drugs.…”

Low rates of specialized cancer consultation and cancer-directed therapy for noncurable pancreatic adenocarcinoma: a population-based analysis

“…There are emerging data showing superior outcomes with highvolume oncology care for cancerdirected therapy. 35 However, a detailed analysis of the effect of institution volume on outcomes for medical cancer care was beyond the scope of this study. In particular, it is difficult to identify the insti tution where a consultation happened, such that the analysis would be limited to volume of cancerdirected therapy delivered by institution and inherently biased.…”

Elective Cancer Surgery in COVID-19–Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study

“…[9][10][11] Before the pandemic, most cancer surgery was performed in hospitals that also supported acute medical services. [12][13][14] Such hospitals have admitted patients with COVID-19 during the pandemic, increasing the risk of cross infection of elective surgery patients. To avoid this, some health care providers have established dedicated COVID-19-free surgical pathways, which deliver surgery, critical care, and inpatient ward care with no shared areas with patients with COVID-19.…”