Geographic disparities in surgical treatment recommendation patterns and survival for pancreatic adenocarcinoma
Previous studies have described pessimistic attitudes of physicians toward recommending surgery for early-stage pancreatic adenocarcinoma. However, the impact of geographic region on recommendation patterns of surgical treatment for potentially resectable pancreatic cancer is unknown. The SEER regis...
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| Veröffentlicht in: | HPB (Oxford, England) England), 2017-11, Vol.19 (11), p.1008-1015 |
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| creator | Salami, Aitua Alvarez, Nkosi H. Joshi, Amit R.T. |
| description | Previous studies have described pessimistic attitudes of physicians toward recommending surgery for early-stage pancreatic adenocarcinoma. However, the impact of geographic region on recommendation patterns of surgical treatment for potentially resectable pancreatic cancer is unknown.
The SEER registry was used to identify patients with early-stage pancreatic adenocarcinoma (AJCC I-II) [2004–2013]. The exposure of interest was geographic region of diagnosis: Midwest, West, Southeast or Northeast. The endpoints of interest were recommendation of no surgery, and overall survival.
A total of 24,408 patients were identified [Midwest – 10.6%, West – 50.1%, Southeast – 21.7% and Northeast – 17.6%]. Overall, 38% of patients had a recommendation of no surgery by their provider. On univariate analysis, the likelihood of having a recommendation of no surgery was lowest in the NE [OR: Northeast (0.8), West (1.6), Southeast (1.3), and Midwest (Ref); p |
| doi_str_mv | 10.1016/j.hpb.2017.07.009 |
| format | Article |
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The SEER registry was used to identify patients with early-stage pancreatic adenocarcinoma (AJCC I-II) [2004–2013]. The exposure of interest was geographic region of diagnosis: Midwest, West, Southeast or Northeast. The endpoints of interest were recommendation of no surgery, and overall survival.
A total of 24,408 patients were identified [Midwest – 10.6%, West – 50.1%, Southeast – 21.7% and Northeast – 17.6%]. Overall, 38% of patients had a recommendation of no surgery by their provider. On univariate analysis, the likelihood of having a recommendation of no surgery was lowest in the NE [OR: Northeast (0.8), West (1.6), Southeast (1.3), and Midwest (Ref); p < 0.05 for all]. This association persisted following risk adjustment. Geographic region was an independent predictor of mortality, irrespective of resection status.
Significant disparities in surgical treatment recommendation patterns and survival for early-stage pancreatic cancer exist based on geographic location. Improved adherence to guideline-driven treatment recommendations, standardization of care processes, and regionalization may help stem the existing variability in care and outcomes.</description><identifier>ISSN: 1365-182X</identifier><identifier>EISSN: 1477-2574</identifier><identifier>DOI: 10.1016/j.hpb.2017.07.009</identifier><identifier>PMID: 28838634</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Female ; Healthcare Disparities - trends ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Odds Ratio ; Pancreatectomy - adverse effects ; Pancreatectomy - mortality ; Pancreatectomy - trends ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Practice Patterns, Physicians' - trends ; Process Assessment (Health Care) - trends ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; SEER Program ; Time Factors ; Treatment Outcome ; United States - epidemiology</subject><ispartof>HPB (Oxford, England), 2017-11, Vol.19 (11), p.1008-1015</ispartof><rights>2017 International Hepato-Pancreato-Biliary Association Inc.</rights><rights>Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-aa084fae7e628e0780f29d68b86499e10464547dfaa95c249d87e969d90842563</citedby><cites>FETCH-LOGICAL-c396t-aa084fae7e628e0780f29d68b86499e10464547dfaa95c249d87e969d90842563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28838634$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Salami, Aitua</creatorcontrib><creatorcontrib>Alvarez, Nkosi H.</creatorcontrib><creatorcontrib>Joshi, Amit R.T.</creatorcontrib><title>Geographic disparities in surgical treatment recommendation patterns and survival for pancreatic adenocarcinoma</title><title>HPB (Oxford, England)</title><addtitle>HPB (Oxford)</addtitle><description>Previous studies have described pessimistic attitudes of physicians toward recommending surgery for early-stage pancreatic adenocarcinoma. However, the impact of geographic region on recommendation patterns of surgical treatment for potentially resectable pancreatic cancer is unknown.
The SEER registry was used to identify patients with early-stage pancreatic adenocarcinoma (AJCC I-II) [2004–2013]. The exposure of interest was geographic region of diagnosis: Midwest, West, Southeast or Northeast. The endpoints of interest were recommendation of no surgery, and overall survival.
A total of 24,408 patients were identified [Midwest – 10.6%, West – 50.1%, Southeast – 21.7% and Northeast – 17.6%]. Overall, 38% of patients had a recommendation of no surgery by their provider. On univariate analysis, the likelihood of having a recommendation of no surgery was lowest in the NE [OR: Northeast (0.8), West (1.6), Southeast (1.3), and Midwest (Ref); p < 0.05 for all]. This association persisted following risk adjustment. Geographic region was an independent predictor of mortality, irrespective of resection status.
Significant disparities in surgical treatment recommendation patterns and survival for early-stage pancreatic cancer exist based on geographic location. Improved adherence to guideline-driven treatment recommendations, standardization of care processes, and regionalization may help stem the existing variability in care and outcomes.</description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Chi-Square Distribution</subject><subject>Female</subject><subject>Healthcare Disparities - trends</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Staging</subject><subject>Odds Ratio</subject><subject>Pancreatectomy - adverse effects</subject><subject>Pancreatectomy - mortality</subject><subject>Pancreatectomy - trends</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Practice Patterns, Physicians' - trends</subject><subject>Process Assessment (Health Care) - trends</subject><subject>Proportional Hazards Models</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>SEER Program</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><issn>1365-182X</issn><issn>1477-2574</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1r3DAQhkVpadKkP6CX4mMv3kiyrA96KiFJA4FeWshNzErjRMtaciXtQv99ZTbNsTCgAT3vC_MQ8onRDaNMXu02z8t2wylTG9qGmjfknAmlej4q8bbtgxx7pvnjGflQyo5S3mLmPTnjWg9aDuKcpDtMTxmW5-A6H8oCOdSApQuxK4f8FBzsu5oR6oyxdhldmtvmoYYUuwVqxRxLB9Gv-DEcGz6l3H6iW1OtFTzG5CC7ENMMl-TdBPuCH1_eC_Lr9ubn9ff-4cfd_fW3h94NRtYegGoxASqUXCNVmk7ceKm3WgpjkFEhxSiUnwDM6LgwXis00njTcnyUwwX5cupdcvp9wFLtHIrD_R4ipkOxzAy8OdBqRdkJdTmVknGySw4z5D-WUbt6tjvbPNvVs6VtqGmZzy_1h-2M_jXxT2wDvp4AbEceA2ZbXMDo0IcmsVqfwn_q_wIM25Al</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Salami, Aitua</creator><creator>Alvarez, Nkosi H.</creator><creator>Joshi, Amit R.T.</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201711</creationdate><title>Geographic disparities in surgical treatment recommendation patterns and survival for pancreatic adenocarcinoma</title><author>Salami, Aitua ; Alvarez, Nkosi H. ; Joshi, Amit R.T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-aa084fae7e628e0780f29d68b86499e10464547dfaa95c249d87e969d90842563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Chi-Square Distribution</topic><topic>Female</topic><topic>Healthcare Disparities - trends</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Staging</topic><topic>Odds Ratio</topic><topic>Pancreatectomy - adverse effects</topic><topic>Pancreatectomy - mortality</topic><topic>Pancreatectomy - trends</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Practice Patterns, Physicians' - trends</topic><topic>Process Assessment (Health Care) - trends</topic><topic>Proportional Hazards Models</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>SEER Program</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Salami, Aitua</creatorcontrib><creatorcontrib>Alvarez, Nkosi H.</creatorcontrib><creatorcontrib>Joshi, Amit R.T.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>HPB (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Salami, Aitua</au><au>Alvarez, Nkosi H.</au><au>Joshi, Amit R.T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Geographic disparities in surgical treatment recommendation patterns and survival for pancreatic adenocarcinoma</atitle><jtitle>HPB (Oxford, England)</jtitle><addtitle>HPB (Oxford)</addtitle><date>2017-11</date><risdate>2017</risdate><volume>19</volume><issue>11</issue><spage>1008</spage><epage>1015</epage><pages>1008-1015</pages><issn>1365-182X</issn><eissn>1477-2574</eissn><abstract>Previous studies have described pessimistic attitudes of physicians toward recommending surgery for early-stage pancreatic adenocarcinoma. However, the impact of geographic region on recommendation patterns of surgical treatment for potentially resectable pancreatic cancer is unknown.
The SEER registry was used to identify patients with early-stage pancreatic adenocarcinoma (AJCC I-II) [2004–2013]. The exposure of interest was geographic region of diagnosis: Midwest, West, Southeast or Northeast. The endpoints of interest were recommendation of no surgery, and overall survival.
A total of 24,408 patients were identified [Midwest – 10.6%, West – 50.1%, Southeast – 21.7% and Northeast – 17.6%]. Overall, 38% of patients had a recommendation of no surgery by their provider. On univariate analysis, the likelihood of having a recommendation of no surgery was lowest in the NE [OR: Northeast (0.8), West (1.6), Southeast (1.3), and Midwest (Ref); p < 0.05 for all]. This association persisted following risk adjustment. Geographic region was an independent predictor of mortality, irrespective of resection status.
Significant disparities in surgical treatment recommendation patterns and survival for early-stage pancreatic cancer exist based on geographic location. Improved adherence to guideline-driven treatment recommendations, standardization of care processes, and regionalization may help stem the existing variability in care and outcomes.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>28838634</pmid><doi>10.1016/j.hpb.2017.07.009</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - surgery Aged Aged, 80 and over Chi-Square Distribution Female Healthcare Disparities - trends Humans Logistic Models Male Middle Aged Multivariate Analysis Neoplasm Staging Odds Ratio Pancreatectomy - adverse effects Pancreatectomy - mortality Pancreatectomy - trends Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Practice Patterns, Physicians' - trends Process Assessment (Health Care) - trends Proportional Hazards Models Retrospective Studies Risk Factors SEER Program Time Factors Treatment Outcome United States - epidemiology |
| title | Geographic disparities in surgical treatment recommendation patterns and survival for pancreatic adenocarcinoma |
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