Benefits of High-Volume Medical Oncology Care for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis

Abstract

Background: Although pancreatic adenocarcinoma (PA) surgery performed by high-volume (HV) providers yields better outcomes, volume–outcome relationships are unknown for medical oncologists. This study examined variation in practice and outcomes in noncurative management of PA based on medical oncology provider volume. Methods: This population-based cohort study linked administrative healthcare datasets and included nonresected PA from 2005 through 2016. The volume of PA consultations per medical oncology provider per year was divided into quintiles, with HV providers (≥16 patients/year) constituting the fifth quintile and low-volume (LV) providers the first to fourth quintiles. Outcomes were receipt of chemotherapy and overall survival (OS). The Brown-Forsythe-Levene (BFL) test for equality of variances was performed to assess outcome variability between provider-volume quintiles. Multivariate regression models were used to examine the association between management by HV provider and outcomes. Results: A total of 7,062 patients with noncurable PA consulted with medical oncology providers. Variability was seen in receipt of chemotherapy and median survival based on provider volume (BFL, P<.001 for both), with superior 1-year OS for HV providers (30.1%; 95% CI, 27.7%–32.4%) compared with LV providers (19.7%; 95% CI, 18.5%–20.6%) (P<.001). After adjustment for age at diagnosis, sex, comorbidity burden, rural residence, income, and diagnosis period, HV provider care was independently associated with higher odds of receiving chemotherapy (odds ratio, 1.19; 95% CI, 1.05–1.34) and with superior OS (hazard ratio, 0.79; 95% CI, 0.74–0.84). Conclusions: Significant variation was seen in noncurative management and outcomes of PA based on provider volume, with management by an HV provider being independently associated with superior OS and higher odds of receiving chemotherapy. This information is important to inform disease care pathways and care organization. Cancer care systems could consider increasing the number of HV providers to reduce variation and improve outcomes.

Impact of Geography on Care Delivery and Survival for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis

“…57 In addition, given that they must travel far distances to reach even their closest centers, remote patients may more frequently bypass these centers to access cancer services in larger communities and thus receive care from highervolume providers with superior outcomes. 58,59 Planning of cancer care should pay particular attention to patients living at moderate distances from cancer centers and potentially learn from measures in place for those living at extreme distances.…”

“…Patient preferences or provider practice patterns, including provider clinical volume, favoring less-aggressive treatment approaches may also play a role. 59 High survival despite low medical oncology consultation occurred in regions that also had lower rates of CDT. This trend could therefore be due to regional biases toward more aggressive treatment among those who do receive CDT, offsetting low survival among those who do not.…”

A novel combination of percutaneous stenting with iodine-125 seed implantation and chemotherapy for the treatment of pancreatic head cancer with obstructive jaundice

“…The high expression of the multidrug resistance genes in pancreatic cancer cells makes pancreatic cancer less sensitive to chemotherapy. Currently, gemcitabine-based chemotherapy is considered to be the first-line standard treatment for advanced pancreatic cancer, but the response rate of systemic intravenous chemotherapy for gemcitabine alone is only 5%e10% (37,38). The chemotherapy was performed through arterial infusion, and there were no obvious complications of biliary tract infection.…”

Geographic impact on access to care and survival for non-curative esophagogastric cancer: a population-based study

“…Provision of care by high-volume providers has long been associated with superior outcomes for cancer surgery [62][63][64]. More recently, care by high-volume medical oncologists has been associated with superior receipt of chemotherapy and overall survival [4,65]. In non-curative esophagogastric cancer, high-volume medical oncologists have also been associated with lower healthcare costs [66].…”