Low rates of specialized cancer consultation and cancer-directed therapy for noncurable pancreatic adenocarcinoma: A population-based analysis

Abstract

BACKGROUND: Although advancements in systemic therapy have improved the outlook for pancreatic adenocarcinoma, it is not known if patients get access to these therapies. We aimed to examine the patterns and factors associated with access to specialized cancer consultations and subsequent receipt of cancerdirected therapy for patients with noncurative pancreatic adenocarcinoma. METHODS: We conducted a populationbased analysis of noncurative pancreatic adenocarcinoma diagnosed over 2005-2016 in Ontario by linking administrative health care data sets. Our primary outcomes were specialized cancer consultation and receipt of cancerdirected therapy (chemotherapy or a combination of chemo and radiation therapy [chemoradiation therapy]). We examined specialized cancer consultation with hepatopancreaticobiliary surgery, medical and radiation oncology. We used multivariable logistic regression to identify factors associated with medical oncology consultation and cancerdirected therapy. RESULTS: Of 10881 patients, 64.9% had a consultation with specialists in medical oncology, 35.1% with hepatopancreaticobiliary surgery and 24.7% with radiation oncology. Sociodemographic characteristics were not associated with the likelihood of medical oncology consultation. Of these patients, 4144 received cancerdirected therapy, representing 38.1% of all patients and 58.6% of those who consulted with medical oncology. Of 6737 patients not receiving cancerdirected therapy, 2988 (44.4%) had a consultation with medical oncology. Older age and lowest income quintile were independently associated with lower likelihood of cancerdirected therapy. If the first specialized cancer consultation was with medical or radiation oncology, the likelihood of cancerdirected therapy was significantly higher compared with surgery. INTERPRETATION: A considerable proportion of patients with noncurable pancreatic adenocarcinoma in Ontario did not have a specialized cancer consultation and most did not receive cancerdirected therapy. We identified disparities in specialized cancer consultation and receipt of systemic cancerdirected therapy that indicate potential gaps in assessment.