Variations in Medical Oncology Utilization for Pancreatic Cancer Patients in Nova Scotia

Introduction Population studies have shown that only the minority of pancreatic cancer patients receive cancer directed therapy. Methods Primary aim of this study was to evaluate the referral rate for systemic chemotherapy, as a proxy for the quality of health care delivered to patients with pancreatic cancer in the province of Nova Scotia (Canada). The study population included a cohort of all patients older than 18 years of age who had the diagnosis of PC over a ten year period (April 1, 2001-March 31, 2011). Diagnostic codes of the International Classification of Disease for Oncology, 3rd edition were used to select patients with pancreatic cancer from the Nova Scotia Cancer Registry. Univariate and multivariate analyses were used to assess characteristics associated with the likelihood of receiving cancer directed therapy in the form of adjuvant or palliative chemotherapy. Results A total of 1,161 patients were included with mean age of 72 years. Elixhauser comorbdity score >1 was present in 41% of the cohort with 31% of patients living in rural areas and 40% belonging to low income groups. Surgical therapy was performed in 11.7%. Among patients who underwent resection, 60% were referred to medical oncologists for adjuvant chemotherapy vs. 36% for patients who were not surgical candidates (P<0.0001). Medical oncology consultations were completed only in 46% of patients who underwent surgical therapy vs. 31% of patients who were not surgical candidates (P<0.0001). Multivariate analysis of factors associated with referral to medical oncology services were younger age and low comorbidity status. Conclusions In Nova Scotia, cancer directed therapy in the form of surgery or chemotherapy for PC is offered only to a minority of patients. Rates of cancer directed therapy may reflect appropriate considerations of patients' preferences and functional status, however, other factors, including physicians' attitudes, may play a significant role. Received September 23rd, 2016 Accepted November 18th, 2016