A Pancreatic Cancer Multidisciplinary Clinic Eliminates Socioeconomic Disparities in Treatment and Improves Survival
Ann Surg Oncol . 2021 Feb 1. doi: 10.1245/s10434-021-09594-8. Online ahead of print.
Richard S Hoehn, Caroline J Rieser, Sharon Winters, Lauren Stitt, Melissa E Hogg, David L Bartlett, Kenneth K Lee, Alessandro Paniccia, James P Ohr, Vikram C Gorantla, Anuradha Krishnamurthy, John C Rhee, Nathan Bahary, Adam C Olson, Steve Burton, Susannah G Ellsworth, Adam Slivka, Kevin McGrath, Asif Khalid, Kenneth Fasanella, Jennifer Chennat, Randal E Brand, Rohit Das, Ritu Sarkaria, Aatur D Singhi, Herbert J Zeh, Amer H Zureikat
Aims: National studies have demonstrated disparities in the treatment and survival of pancreatic cancer patients based on socioeconomic status (SES). This study aimed to identify specific differences in perioperative management and outcomes based on patient SES and to study the role of a multidisciplinary clinic (MDC) in mitigating any variations.
Methods: The study analyzed patients undergoing pancreaticoduodenectomy for pancreatic ductal adenocarcinoma in a large hospital system. The patients were categorized into groups of high and low SES and whether they were managed by the authors' pancreatic cancer MDC or not. The study compared differences in disease characteristics, receipt of multimodality therapy, perioperative outcomes, and recurrence-free and overall survival.
Results: Of the 162 low-SES patients and 119 high-SES patients, 54% were managed in the MDC. Outside the MDC, low-SES patients were less likely to receive neoadjuvant chemotherapy and had less minimally invasive surgery, a longer OR time, less enhanced recovery participation, and more major complications (p < 0.05). No SES disparities were observed among the MDC patients. Despite similar tumor characteristics, the low-SES patients had inferior median overall survival (21 vs 32 months; p = 0.005), but the MDC appeared to eliminate this disparity. Low SES correlated with inferior survival for the non-MDC patients (17 vs 32 months; p < 0.001), but not for the MDC patients (24 vs 25 months; p = 0.33). These findings persisted in the multivariable analysis.
Conclusion: A pancreatic cancer MDC standardizes treatment decisions, eliminates disparities in surgical outcomes, and improves survival for low-SES patients.
Read Full Article Here: https://doi.org/10.1245/s10434-021-09594-8