Eighty percent of patients with advanced or metastatic pancreatic adenocarcinoma are not candidates for surgical resection and require noncurative therapy, including multi-agent chemotherapy regimens, radiation therapy, nerve blocks and other symptomatic relief modalities. Despite having established benefits for patients, a large proportion of pancreatic adenocarcinoma patients are unable to access these treatments due to barriers and disparities in cancer-directed therapy delivery. Using administrative healthcare data, eligible 10,881 patients with newly diagnosed noncurative pancreatic adenocarcinoma in Ontario, Canada, between the years 2005 and 2016 were followed up to examine patterns and factors associated with access to specialized cancer care and receipt of cancer-directed therapy in this patient population. With a median age at diagnosis of 72 years (IQR 62 to 80 years), median survival was reported to be 3.3 months (IQR 1.2 to 8.5 months). Researchers found that 26.6% of patients received systemic chemotherapy, 11.5% received chemoradiation, and 61.9% received best supportive care. In terms of specialized cancer consultations, 64.9% had a consultation with a medical oncologist, 35.1% with a hepatopancreatico-biliary surgeon and 24.7% with a radiation oncologist following diagnosis. Thirty-eight percent of patients received cancer-directed therapy, representing 58.6% of those who had consults with medical oncology. Of those who did not receive cancer-directed therapy, only 44.4% had a consultation with medical oncology. Older age and lowest income quartile were associated with lower likelihood of cancer-directed therapy, and consultation with medical or rational oncology was associated with a significantly higher likelihood of a cancer-directed therapy pathway compared to a surgical pathway. The findings of this study therefore suggest persistent disparities in specialized cancer consultation and systemic cancer-directed therapy receipt in patients with non-curable pancreatic adenocarcinoma in Ontario, underlining important gaps to be addressed from a health systems perspective.
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