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

Figures & data

Table 1. Characteristics of all patients and of patients distributed according to oncological facility type (numbers and percent).

				Patients according to facility type
		All patients		Tertiary		Secondary
Variable	Strata	N	%	N	%	N	%	p-value^a
Gender	Male	1404	53	1010	54	394	50	0.10
	Female	1251	47	863	46	388	50
Age (25 and 75%-percentiles)	<62 years	662	25	480	26	182	23	0.04
	62-74 years	1334	50	953	51	381	49
	>74 years	659	25	440	23	219	28
Charlsons Comorbidity Index	0	1140	43	845	45	295	38	<0.001
	1-2	928	35	660	35	268	34
	>2	587	22	368	20	219	28
Distant metastasis	Not present	995	37	700	37	295	38	0.87
	Present	1660	63	1173	63	487	62
Pathologically verified diagnosis	No	138	5	90	5	48	6	0.16
	Yes	2517	95	1783	95	734	94
Surgical resection after chemotherapy	No	2563	97	1793	96	770	98	<0.001
	Yes	92	3	80	4	12	2
Cancer pathway participation	No	646	24	484	26	162	21	<0.01
	Yes	2009	76	1389	74	620	79
Type of 1^st line chemotherapy	Gemcitabine	1094	41	629	34	465	59	<0.001
	Gemcitabine combinations	814	31	662	35	152	19
	Folfirinox	676	25	523	28	153	20
	Other regimens	71	3	59	3	12	1
Lines of chemotherapy in total per patient	1	1499	56	1000	53	499	64	<0.001
	2	614	23	455	24	159	20
	>2	542	20	418	22	124	16
Muncipality category^b	Remote area	242	9	146	8	96	12	<0.001
	Rural	824	31	597	32	227	29
	Regional	418	16	228	12	190	24
	Metropolitan	1166	44	897	48	269	34

^aResults of Pearson Chi-square test for difference among facility types.

^bFive patients with unknown municipality.

Figure 1. (a) The distribution of chemotherapy regimens used for first line treatment according to year of treatment initiation. (b) The distribution of chemotherapy regimens used for first line treatment according to year of treatment initiation and facility type (tertiary and secondary).

Figure 2. (a) The overall survival for patients with pancreatic cancer treated with chemotherapy as first line treatment according to facility type for all patients. The mOS was 7.7 and 6.1 months, respectively (p = .0001). (b) The overall survival for patients with pancreatic cancer treated with chemotherapy as first line treatment according to facility type for patients without distant metastases. The mOS was 10.0 and 7.7 months, respectively (p = .001). (c) The overall survival for patients with pancreatic cancer treated with chemotherapy as first line treatment according to facility type for patients with distant metastases. The mOS was 6.6 and 5.4 months, respectively (p = .02).

Figure 3. The overall survival for patients with pancreatic cancer treated with chemotherapy as first line treatment in 2012–2016 and in 2017–2018. The mOS was 8.1 and 7.0 months, respectively (p < .0001).

Table 2. Results of multivariate Cox regression analyses of survival with facility as independent variable, excluding (Model 1) and including type of chemotherapy (Model 2).

		Model 1			Model 2
Variable	Strata	HR	(CI)	p-value	HR	(CI)	p-value
Type of chemotherapy	Gemcitabine			–	1.00		<.001
	Gemcitabine combinations				0.68	(0.61–0.76)
	Folfirinox				0.59	(0.53–0.66)
	Others				0.56	(0.43–0.71)
Facility type	Tertiary	1.00		0.001	1.00		.23
	Secondary	1.16	(1.07–1.27)		1.06	(0.97–1.15)
Age (years)	Continuos	1.02	(1.01–1.02)	<0.001	1.01	(1.00–1.01)	.004
Gender	Male	1.00		0.13	1.00		.13
	Female	0.94	(0.87–1.02)		0.95	(0.87–1.02)
Charlson Comorbidity Index	0	1.00		0.04	1.00		.09
	1–2	1.02	(0.93–1.11)		1.01	(0.92–1.10)
	>2	1.13	(1.03–1.26)		1.11	(1.00–1.23)
Distant metastases	No	1.00		<0.001	1.00		<.001
	Yes	1.54	(1.41–1.67)		1.56	(1.43–1.69)
Year of first treatment	2012	1.00		<0.001	1.00		.01
	2013	0.96	(0.83–1.11)		1.02	(0.89–1.19)
	2014	0.84	(0.72–0.97)		0.94	(0.82–1.10)
	2015	0.88	(0.76–1.03)		1.00	(0.86–1.17)
	2016	0.85	(0.73–0.99)		0.98	(0.83–1.14)
	2017	0.75	(0.65–0.88)		0.86	(0.74–1.01)
	2018	0.67	(0.58–0.78)		0.80	(0.68–0.93)

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.