Opportunity Costs of Surgical Resection and Perioperative Chemotherapy for Locoregional Pancreatic Adenocarcinoma

Abstract

PURPOSE Given the perioperative morbidity and intensity of multimodality treatment, patients with resected pancreatic ductal adenocarcinoma (PDAC) spend a substantial amount of time in clinical care. The primary aim was to determine total time spent in multimodality care for patients with locoregional PDAC. METHODS A cohort study of all patients who underwent curative-intent resection for PDAC at a single-institution, tertiary care center was performed (2015-2019). Exact times for all relevant visits were abstracted from the primary medical record, and travel time was calculated. Care time was divided into preoperative, surgical, radiation, and systemic therapy phases of care. Primary outcome measures were the percentage of total survival time (TST) and percentage of overall survival (OS) days spent in receipt of care. RESULTS One hundred seven patients were included. Patients spent a median of 5.0% (interquartile range [IQR] 2.4%-10.1%) of TST and 11.0% (IQR, 5.7%-20.4%) of OS days in receipt of clinical care. Preoperative, surgical, radiation, and systemic therapy phases of care comprised a median of 0.9% (IQR, 0.4%-2.2%), 3.0% (IQR, 1.9%-6.8%), 4.4% (IQR, 3.6%-6.3%), and 10.0% (IQR, 6.2%-14.1%) of OS days. The median per-visit travel time was 60 minutes (IQR, 32-120), and the median cumulative travel time was 22.0 hours (IQR, 12.0-51.5). 12.1% (n = 13) and 7.8% (n = 4) of patients spent > 10% of TST in receipt of surgical and systemic therapy care, respectively. CONCLUSION Patients with locoregional pancreatic cancer spend a considerable percentage of their survival time in receipt of oncologic care. Further research to determine predictors of increased time burden is warranted to better inform shared decision making.

The Time Toxicity of Cancer Treatment

“…In addition, inherent limitations associated with retrospective data capture (eg, incomplete data, only capturing oncology-related visits, etc) can underestimate true time toxicity. 4,15 Clinical trials represent an ideal context in which to quantify this phenomenon prospectively.…”

“…Clinicians typically lack information necessary to help patients and care partners make fully informed decisions incorporating the impact on their time. 7 Although retrospective analyses have described where people with cancer spend their time, [8][9][10][11][12][13][14][15] patients often have health care needs from the underlying cancer, independent of treatment. These studies therefore make it difficult to ascertain how much additional time toxicity comes from a specific treatment.…”

Finding the Lowest-Cost Pharmacy for Cancer Supportive Care Medications: Not So Easy

“…People with cancer already spend a significant portion of their time pursuing cancer-related care. 1,3,[21][22][23] Adding to confusion and logistic burdens, for a pharmacy that appears on the GoodRx page for zip code 55455, the closest physical pharmacy is almost 400 miles away in Sterling, IL.…”

PABPC1 promotes cell proliferation and metastasis in pancreatic adenocarcinoma by regulating COL12A1 expression

“…Early diagnostic strategies for PAAD remain scarce owing to the lack of specific symptoms and biological markers 2,3 . Currently, surgical excision and chemotherapy are the standard treatments for PAAD; however, achieving a good therapeutic effect in PAAD using these methods is difficult owing to poor prognosis, poor blood supply, and the establishment of an immunosuppressive microenvironment, which may damage the immune system and induce an inflammatory response 4,5 . Moreover, PAAD shows rapid progression, and more than 80% patients with PAAD are diagnosed with inoperable metastatic tumors 6 .…”