Surgery underutilized for early-stage pancreatic cancer
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Key takeaways:
- Only 22% of patients with resectable pancreatic ductal adenocarcinoma underwent surgery.
- Resection and treatment at an NCI-designated center appeared associated with longer survival.
Surgery appeared underutilized for patients with pancreatic ductal adenocarcinoma, according to study findings published in Journal of Surgical Oncology.
An analysis of patients treated between 2004 and 2018 in Texas showed only 22% of those eligible for surgery underwent resection, with surgery utilization rates declining over time.
“The data from Texas likely reflect the situation in other regions across the country, although the severity of the issue might vary among different geographic areas,” Patricio M. Polanco, MD, associate professor of surgery in the division of surgical oncology at UT Southwestern Medical Center, told Healio. “Previous studies have shown that a substantial portion of [patients with early-stage pancreatic cancer] nationwide did not undergo surgery and — despite improvements in surgical safety and treatment options — surgery rates remain low.”
Background and methodology
Curative-intent treatment for patients with localized pancreatic ductal adenocarcinoma (PDAC) require surgery. However, prior studies based on large administrative cancer databases suggest underutilization of surgery for this population.
Polanco and colleagues used the Texas Cancer Registry to identify patients with resectable PDAC treated in Texas between 2004 and 2018. They evaluated clinical and demographic factors associated with failure to operate, as well as the effect of those factors on survival.
Results
Researchers identified 39,157 patients diagnosed with PDAC during the 14-year period, of whom 4,274 were eligible for surgery due to having early-stage disease.
Of those eligible for surgery, 22% underwent resection, 57% were not offered surgery, 6% had comorbidities that precluded them from surgery and 3% refused surgery.
Rates of resection for eligible patients decreased over the study period, declining from 31% in 2004 to 22% in 2018.
Researchers observed an association between older age and failure to operate (OR = 2.55; 95% CI, 1.8-3.61). In contrast, treatment at an American College of Surgeons Commission on Cancer-accredited center appeared associated with a lower likelihood of failure to operate (OR = 0.63; 95% CI, 0.5-0.78).
Patients who underwent resection achieved longer survival (HR = 0.34; 95% CI, 0.31-0.38), as did those treated at NCI-designated cancer centers (HR = 0.79; 95% CI, 0.7-0.89).
Implications and next steps
Five-year survival rates for patients with PDAC are low, and surgery with curative intent could improve outcomes for eligible patients, Polanco and colleagues wrote.
“While significant investments are made in developing new drugs and therapies for pancreatic cancer treatment, it is equally essential to prioritize efforts to improve access to specialized surgical care for this disease,” Polanco told Healio. “Pancreatic surgery is currently the only curative therapy available, making early detection critical for ensuring patients can undergo potentially life-saving surgeries.”
Additional research is underway to determine why surgery rates remain low.
“Our research group is currently investigating the reasons behind the lack of surgery [for] eligible patients and exploring the social determinants of health that may explain this trend,” Polanco said. “Some of our ongoing research aims to identify whether limited access to specialized pancreatic surgery expertise and certain patient and physician beliefs or attitudes toward pancreatic cancer play pivotal roles. Qualitative research trials and implementation science tools are being developed to address these questions.”
References:
- Murimwa GZ, et al. J Surg Oncol. 2023;doi:10.1002/jso.27357.
- Most pancreatic cancer patients don’t get lifesaving surgery (press release). Available at: https://www.utsouthwestern.edu/newsroom/articles/year-2023/july-pancreatic-cancer-patients.html. Published July 24, 2023. Accessed Aug. 16, 2023.
For more information:
Patricio M. Polanco, MD, can be reached at patricio.polanco@UTSouthwestern.edu.
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