Chemotherapy in patients with unresected pancreatic cancer in Australia: A population‐based study of uptake and survival

Dumbrava, Monica; Burmeister, Elizabeth; Wyld, David; Goldstein, David; O’Connell, Dianne; Beesley, Vanessa L.; Gooden, Helen; Janda, Monika; Jordan, Susan J.; Merrett, Neil D.; Payne, Madeleine; Waterhouse, Mary

doi:10.1111/ajco.12862

Cited by 15 publications

(13 citation statements)

References 35 publications

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“…53 A different study of unresected pancreatic cancer indicated that rural living negatively impacted oncology consultation but not receipt of chemotherapy. 54 A similar pattern was also observed for radiation therapy delivery, whereby greater distance was inversely associated with radiation oncology consultation but not with receipt of therapy. 29 Our analysis is unique because it reports on .15,000 patients, combines data on both access to care and receipt of therapy, and assesses both patient-level and region-level trajectories in accessing specialized cancer care.…”

Section: Discussionsupporting

confidence: 52%

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

Yee

Coburn

Davis

et al. 2020

Journal of the National Comprehensive Cancer Network

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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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Section: Discussionsupporting

confidence: 52%

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

Yee

Coburn

Davis

et al. 2020

Journal of the National Comprehensive Cancer Network

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“…Nevertheless, differences in survival due to variation in use of chemotherapy between hospitals seem to have decreased over the study period. During the last decade, on average 34% of patients with metastatic PDAC received chemotherapy in the Netherlands compared to 17-58% [9,10,15,[19][20][21][22] reported from other countries. Between 2007-2011 and 2012-2016, an increase was observed in the use of chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Implementation of contemporary chemotherapy for patients with metastatic pancreatic ductal adenocarcinoma: a population-based analysis

et al. 2020

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2020) Implementation of contemporary chemotherapy for patients with metastatic pancreatic ductal adenocarcinoma: a population-based analysis, Acta Oncologica, 59:6, 705-712, 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. ARTICLE HISTORYmedian overall survival) [4]. Over the years, several combination chemotherapy regimens have been investigated without any gain of survival [5,6]. More recently, FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) was associated with a survival benefit compared to gemcitabine (11.1 vs. 6.8 months median overall survival) in patients with a good performance status [7]. The phase III MPACT trial revealed a

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“…14,[30][31][32] Some small studies that examined referral patterns were limited by smaller sample sizes or also encompassed cura tive management, which confused the results. 11,12 Rates of medi cal oncology consultations for noncurative pancreatic adenocar cinoma have been reported at 31% in Nova Scotia and 54% in Alberta, with older age and higher comorbidity burden associ ated with no consultation. 11,33 Our analysis adds to knowledge in this area, as it involves over 10 000 patients, combines data on both access to care and receipt of therapy, and assesses the trajectory in accessing specialized cancer care.…”

Section: Discussionmentioning

confidence: 99%

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

Mavros

Coburn

Davis

et al. 2019

CMAJ

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espite substantial improvements in cancer care, mortal ity from pancreatic adenocarcinoma is largely unchanged. 1,2 The only option for curative treatment is pancreatectomy. 3 However, 80% of patients who present with advanced or metastatic disease are not candidates for resection and require noncurative management. 4 Contemporary multiagent chemotherapy regimens can improve symptoms, extend median survival for up to 11 months and delay clinical deterioration in patients with advanced pan creatic adenocarcinoma. 5-7 The American Society of Clinical Oncology guideline update in 2018 included chemotherapy for the noncurative management of pancreatic adenocarcinoma in most patients. 6 In addition, radiation therapy, nerve blocks and other modalities can be employed to reduce symptom burden. 8-10 However, these multimodality treatments require specialized management by a multidisciplinary team of cancer specialists.

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Chemotherapy in patients with unresected pancreatic cancer in Australia: A population‐based study of uptake and survival

Abstract: These findings highlight the need to establish referral pathways to ensure that all patients have the opportunity to discuss treatment options with a medical oncologist. This is particularly relevant for health care systems covering areas with a geographically dispersed population.

Cited by 15 publications

References 35 publications

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

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

Implementation of contemporary chemotherapy for patients with metastatic pancreatic ductal adenocarcinoma: a population-based analysis

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

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