Study Identifies Gaps in Treatment Access Among Patients with Pancreatic Cancer

A large proportion of patients with pancreatic cancer do not receive cancer-directed treatment that may extend survival, according to a study published in the Canadian Medical Association Journal.

Pancreatic cancer, which is often diagnosed in advanced stages, has a high mortality rate. Despite advancements in systemic therapy for the disease, it is currently unknown how many patients gain access to these treatments, according to the study.

Currently, the only curative treatment option is pancreatectomy; however, the majority of patients with advanced disease are not candidates for resection and require noncurative management.

For the study, the authors aimed to examine the patterns and factors associated with access to specialized cancer consultations and receipt of cancer-directed therapy for patients with non-curative pancreatic adenocarcinoma. To do this, they conducted a population-based analysis of noncurative pancreatic adenocarcinoma diagnosed from 2005 to 2016.

Of the 10,881 patients included in the study, 64.9% had a consultation with specialists in medical oncology, 35.1% with hepatopancreatico-billary surgery, and 24.7% with radiation oncology. Approximately 38% of these patients received cancer-directed therapy and 58.6% of the patients who received the therapy consulted with medical oncology, according to the findings. The study also showed 44.4% of the 6737 patients not receiving cancer-directed therapy had a consultation with medical oncology.

Overall, the researchers determined that older age and lowest income quintile were independently associated with a lower likelihood of cancer-directed therapy, indicating gaps in patient access to such therapies. Additionally, the likelihood of cancer-directed therapy was significantly higher compared with surgery if the first specialized cancer consultation was with medical or radiation oncology.

“Our results suggest a possible lack of informed discussion regarding cancer-directed therapy,” the authors wrote in the study. “Knowing that a patient’s initial negative perception of the risks and benefits of chemotherapy is not associated with the receipt of chemotherapy, communication and shared decision-making with oncology providers is critical.”

The researchers noted that contemporary multiagent chemotherapy regimens can improve symptoms, extend median survival for up to 11 months, and delay clinical deterioration in patients with advanced pancreatic cancer. Multimodality treatments with the addition of radiation therapy, nerve blocks, and more, can also be used to reduce symptom burden, they noted.

Overall, the researchers concluded that despite the established benefits of these therapies, many patients with pancreatic cancer may not be able to access them. Understanding these gaps can help ensure all patients are given equal opportunities for assessment and treatment.

“To optimize delivery of care in patients with noncurative pancreatic adenocarcinoma, it is imperative to roadmap the patterns of health care delivery, and identify barriers and disparities in the delivery of cancer-directed therapy,” the authors wrote.

References

Mavros MN, Coburn NG, Davis LE, et al. Low rates of specialized cancer consultation and cancer-directed therapy for noncurable pancreatic adenocarcinoma: a population-based analysis. Canadian Medical Association Journal. 2019. Doi: https://doi.org/10.1503/cmaj.190211