Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancer

Abstract

Aim

Academic and high volume hospitals have better outcome for pancreatic cancer (PC) surgery, but there are no reports on oncological treatment. We aimed to determine the influence of facility types on overall survival (OS) after treatment with chemotherapy for inoperable PC.

Material and methods

2,657 patients were treated in Denmark from 2012 to 2018 and registered in the Danish Pancreatic Cancer Database. Facilities were classified as either secondary oncological units or comprehensive, tertiary referral cancer centers.

Results

The average yearly number of patients seen at the four tertiary facilities was 71, and 31 at the four secondary facilities. Patients at secondary facilities were older, more frequently had severe comorbidity and lived in non-urban municipalities. As compared to combination chemotherapy, monotherapy with gemcitabine was used more often (59%) in secondary facilities than in tertiary (34%). The unadjusted median OS was 7.7 months at tertiary and 6.1 months at secondary facilities. The adjusted hazard ratio (HR) of 1.16 (confidence interval 1.07–1.27) demonstrated an excess risk of death for patients treated at secondary facilities, which disappeared when taking type of chemotherapy used into account. Hence, more use of combination chemotherapy was associated with the observed improved OS of patients treated at tertiary facilities. Declining HR’s per year of first treatment indicated improved outcomes with time, however the difference among facility types remained significant.

Discussion

Equal access to modern combination chemotherapy at all facilities on a national level is essential to ensure equality in treatment results.

Keywords:

• Chemotherapy
• disparity
• hospital facility
• pancreas cancer
• prognosis

Acknowledgements

All departments treating PC in Denmark contribute with data for the DPCD. The members of both DPCD and DPCG represent surgeons, oncologists, radiologists, and pathologists from the participating institutions. We acknowledge Birgitta Wanda Nielsen for expert technical assistance.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Patients are not completely anonymised and data can therefore not be shared. The data are extracted from the Danish healthcare registries by the Danish Health Data Authority. These data are available to researchers upon application and can only be obtained with permission from the Danish Data Protection Agency, who gave the permission to conduct this study.

Additional information

Funding

Both DPCD and DPCG receive funding from Danish Regions, and DPCD receives statistical, epidemiological, and data management support free of charge from Danish Regions. Likewise, the running costs of the online database are funded by Danish Regions. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.