ORLANDO — Teaching hospitals offer state-of-the-art multimodal therapy for pancreatic cancer, but community hospitals not affiliated with academic centers tend to treat with pancreatic resection only, according to a poster presented at a symposium on gastrointestinal cancers sponsored by the American Society of Clinical Oncology.
Offering stage-specific treatment to the appropriate patients will improve cancer care in the community, Dr. Karl Y. Bilimoria of Northwestern University, Chicago, said at the symposium, which was also sponsored by the AGA Institute, the American Society for Therapeutic Radiology and Oncology, and the Society of Surgical Oncology.
Dr. Bilimoria led a retrospective study that evaluated various aspects of pancreatic cancer treatment in the United States over a 19-year period. “The morbidity and mortality after pancreatic surgery has decreased in recent years, and several trials have shown improved outcomes with multimodal therapy, which includes chemotherapy, radiation, and surgery.
But national practice patterns in the management of pancreatic cancer were poorly defined, and we wanted to shed some light on the use of treatment relative to hospital characteristics,” he explained at the poster presenting their work.
The investigators used the National Cancer Data Base to analyze treatment patterns for 301,033 patients with pancreatic cancer from 1,667 institutions during two time periods: 1985–1994 and 1995–2003.
They found that the cancer stage at presentation did not differ for the two time periods, but that the percentage of patients receiving treatment for their cancer increased significantly (P less than .0001), from 45.1% in the first time period (57,188 patients out of a total of 126,891) to 51.8% (90,222 patients out of a total of 174,172) in the second time period.
The analysis also revealed the following shifts in treatment patterns (all of the changes were significant at P less than .0001):
▸ Pancreatectomy for localized stage I and II disease increased from 36.9% to 49.3%.
▸ Chemotherapy after curative resection increased from 4.1% to 5.7%.
▸ Radiation therapy after curative resection decreased, from 7.0% to 4.6%.
▸ Adjuvant chemoradiation increased from 26.8% to 38.7%.
▸ Surgery alone decreased from 62.1% to 49.9%.
High-volume academic centers were significantly more likely to offer pancreatectomy and adjuvant chemoradiation therapy than were community institutions (P less than .0001), Dr. Bilimoria reported.
“We were not surprised by this finding, but it was important to document the disparity in treatment so that we can go back and say to the community hospitals that perhaps they should look more closely at utilization rates of adjuvant chemoradiation therapy at their institutions,” Dr. Bilimoria said in an interview.
It is possible that community hospitals may be seeing older patients or sicker patients, and these factors may be influencing their utilization of adjuvant treatments. “They may, in fact, be treating appropriately, so we need to do more work to investigate this,” he said.
Dr. Bilimoria added that one of the more interesting findings of the study was that the National Comprehensive Cancer Network institutions used multimodal therapy significantly more often than did academic centers (P less than .0001).
“The NCCN centers have dedicated resources to give state-of-the-art therapy for pancreatic cancer, and they also tend to have special patient populations who come especially to them for their treatment. But we need to identify utilization patterns that we can also bring to community hospitals, without having to talk about regionalization of care. This would definitely improve outcomes at community hospitals,” he said.