Treatment patterns and outcomes in pancreatic cancer: A comparative analysis of Ontario and the USA Journal Article
| Authors: | Saadat, L. V.; Schofield, E.; Bai, X.; Curry, M.; Saskin, R.; Lipitz-Snyderman, A.; Soares, K. C.; Kingham, T. P.; Jarnagin, W. R.; D’Angelica, M. I.; Wright, F. C.; Irish, J. C.; Coburn, N. G.; Wei, A. C. |
| Article Title: | Treatment patterns and outcomes in pancreatic cancer: A comparative analysis of Ontario and the USA |
| Abstract: | Background: Comparative studies evaluating quality of care in different healthcare systems can guide reform initiatives. This study seeks to characterize best practices by comparing utilization and outcomes for patients with pancreatic cancer (PC) in the USA and Ontario, Canada. Methods: Patients (age ≥ 66 years) with PC were identified from the Ontario Cancer Registry and SEER-Medicare databases from 2006 to 2015. Demographics and treatment (surgery, radiation, chemotherapy, or multimodality (surgery and chemotherapy)) were described. In resected patients, neoadjuvant therapy, readmission, and 30- and 90-day postoperative mortality rates were calculated. Survival was assessed using Kaplan–Meier curves. Results: This study includes 38,858 and 11,512 patients with PC from the USA and Ontario, respectively. More female patients were identified in the USA (54.0%) versus Ontario (46.9%). In the entire cohort, US patients received more radiation in addition to other therapies (18.8% vs. 13.5% Ontario) and chemotherapy alone (34.3% vs. 19.0% Ontario). While rates of resection were similar (13.4% USA vs.12.5% Ontario), multimodality therapy was more common in the UAS (9.0% vs. 6.4%). Among resected patients, neoadjuvant chemotherapy was uncommon in both groups, although more frequent in the USA (12.0% vs. 3.2% Ontario). The 30- and 90-day postoperative mortality rates were lower in Ontario vs. the USA (30-day: 3.26% vs. 4.91%; 90-day: 7.08% vs. 10.96%), however, overall survival was similar between the USA and Ontario. Conclusions: We observed substantive differences in treatment and outcomes between PC patients in the USA and Ontario, which may reflect known differences in healthcare systems. Close evaluation of healthcare policies can inform initiatives to improve care quality. © 2023, Society of Surgical Oncology. |
| Keywords: | cancer chemotherapy; treatment outcome; aged; survival analysis; cancer surgery; survival rate; retrospective studies; major clinical study; overall survival; multimodality cancer therapy; united states; cancer patient; cancer radiotherapy; comparative study; pancreas cancer; combined modality therapy; neoadjuvant therapy; pancreatic neoplasms; antineoplastic agent; pancreaticoduodenectomy; cohort analysis; data base; retrospective study; age; pancreas carcinoma; health care utilization; register; registries; adjuvant chemotherapy; public health; pancreas tumor; pancreatectomy; surgical mortality; cancer registry; hospital readmission; neoadjuvant chemotherapy; epidemiology; distal pancreatectomy; sex; demographics; mortality rate; national health programs; pancreatic carcinoma; ontario; cancer prognosis; very elderly; humans; human; male; female; article |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 31 |
| Issue: | 1 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2024-01-01 |
| Start Page: | 58 |
| End Page: | 65 |
| Language: | English |
| DOI: | 10.1245/s10434-023-14375-6 |
| PUBMED: | 37833463 |
| PROVIDER: | scopus |
| PMCID: | PMC11614116 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in PubMed and PDF -- Corresponding author is MSK author: Alice C. Wei -- Source: Scopus |
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