Physician attitudes and treatment patterns for pancreatic cancer

Abstract

BackgroundSurgery appears to be an underutilized treatment option for pancreatic cancer. Nihilistic physician attitudes may be partly responsible. The study objectives were to analyze physician attitudes towards this disease and determine treatment patterns and outcomes including rates of surgical referral.MethodsA survey was administered to 420 physicians in Manitoba to document general knowledge and attitudes. Population based administrative data was accessed for all patients diagnosed with pancreatic cancer between 2004 and 2006 to examine treatment patterns and outcomes.Results181 physicians responded to the survey. Most (73%) believed that surgical resection was worthwhile. Of the 413 Manitobans diagnosed with pancreatic cancer, only 11% underwent an attempt at surgical resection. There were 124 patients with stage I or II disease (i.e. potentially resectable), 85 of these patients received no treatment and 39% were not referred to a surgeon. These patients were older than those referred, but did not have more comorbidities.ConclusionMost physicians were insightfully aware of both the survival benefit and potential risks of surgical resection. However, some did overestimate the surgical mortality and underestimate the associated survival benefit. Although advanced age may justly account for some of the patients not receiving a referral, it is reasonable to assume that nihilistic physician attitudes is contributing to the apparent underutilization of surgery for pancreatic cancer. Efforts should be made to ensure that eligible patients are at least offered surgery as a potential treatment option.

A contemporary analysis of survival for resected pancreatic ductal adenocarcinoma

“…Yet, in spite of modest progress in these ancillary oncological modalities, surgical intervention, the primary contributor to potential cure, is largely underutilized for pancreatic cancer in the United States . This may reflect outdated beliefs regarding post‐operative morbidity and mortality rates from the physician referral base …”

“…16 This may reflect outdated beliefs regarding post-operative morbidity and mortality rates from the physician referral base. 17 Furthermore, the reporting standards for surgical outcomes have changed in recent years to address ambiguities in surgical terminology. The Toronto group has developed and subsequently refined an increasingly popular complication grading scale based on clinical impact.…”

Thromboprophylaxis in Pancreatic Cancer: Why isn’t Prime Time Here Compared to Multiple Myeloma?

“…Despite the introduction of new combination chemotherapies, median survival of patients with APC remains less than 1 year. Patients with pancreatic cancers remain unfortunate in that despite eligibility, many patients are not offered radical treatments even at early stages of diagnosis [20]. Therefore it is not surprising that these patients are declined VTE prophylaxis by the attending physicians at their advanced stages.…”

Are Quality Indicators associated with Postoperative Outcomes after Resection for Pancreatic Adenocarcinoma?

“…Except for surgery, other treatments have shown modest impact on patients' survival and are often underutilized [3][4][5][6][7][8][9]. Since there are no cost-effective screening tests, a high clinical suspicion is necessary for the diagnosis of early stage tumors2 and the majority of patients are diagnosed with locally advanced or metastatic disease [2,3].…”

“…Besides established prognostic factors such as cellular differentiation, lymph vascular infiltration and tumor stage, there may be other reasons responsible for the low survival rate of these patients. Several groups have reported that PC patients receive one of the lowest rates of cancer-directed therapy among all the solid tumors [4][5][6][7][8][9][10] and treatments may differ based upon patients' socioeconomic status (education level, income), place of residence (rural vs. urban), number of procedures performed in a health system (low vs. high volume hospital) and physician expertise [4][5][6][7][8][9][10].…”