Defining Value for Pancreatic Surgery in Early-Stage Pancreatic Cancer

Bateni, Sarah B.; Gingrich, Alicia A.; Hoch, Jeffrey S.; Canter, Robert J.; Bold, Richard J.

doi:10.1001/jamasurg.2019.3019

Cited by 28 publications

(16 citation statements)

References 41 publications

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“…48 Similarly, a retrospective study using the CCR found no differences by race, ethnicity, or SES in survival following resection for stages I/II pancreatic cancer after controlling for age, sex, comorbidity, tumor stage and grade, type of surgery, chemotherapy, and surgical volume of the hospital. 49…”

Section: Resultsmentioning

confidence: 99%

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Disparities in Pancreatic Cancer Treatment and Outcomes

Noel

Fiscella

2019

Health Equity

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Pancreatic cancer remains a major health concern; in the next 2 years, it will become the second leading cause of cancer deaths in the United States. Health disparities in the treatment of pancreatic cancer exist across many disciplines, including race and ethnicity, socioeconomic status (SES), and insurance. This narrative review discusses what is known about these disparities, with the goal of highlighting targets for equity promoting interventions. Methods: We performed a narrative review of health disparities in pancreatic cancer spanning greater than ten areas, including epidemiology, treatment, and outcome, using the PubMed NIH database from 2000 to 2019 in the Unites States. Results: African Americans (AAs) tend to present at diagnosis with later stage disease. AAs and Hispanics have lower rates of surgical resection, are more likely to be treated at low volume hospitals, and often experience higher rates of morbidity and mortality compared to white patients, although control for confounders is often limited. Insurance and SES also factor into the delivery of treatment for pancreatic cancer. Conclusion: Disparities by race and SES exist in the diagnosis and treatment of pancreatic cancer that are largely driven by race and SES. Improved understanding of underlying causes could inform interventions.

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Section: Resultsmentioning

confidence: 99%

“…22 The finding of comparable outcomes following surgery (when controlling for surgical volume) may extend to some regions. 49…”

Section: Resultsmentioning

confidence: 99%

Disparities in Pancreatic Cancer Treatment and Outcomes

Noel

Fiscella

2019

Health Equity

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“…Surgical volume and expertise have an impact on both clinical and oncologic outcomes in patients treated for borderline resectable and resectable PC . Few centers with an annual volume of more than 20 MIPS procedures for PC have published their outcomes, and available data are too heterogenous to allow comparative analysis .…”

Section: Discussionmentioning

confidence: 99%

“…Surgical volume and expertise have an impact on both clinical and oncologic outcomes in patients treated for borderline resectable and resectable PC. 24 Few centers with an annual volume of more than 20 MIPS procedures for PC have published their outcomes, and available data are too heterogenous to allow comparative analysis. 25 After pancreatic surgery, the absolute differences in adjusted mortality between the lowest and highest volume hospitals were found to be among the highest.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Survival After Minimally Invasive vs Open Surgery for Pancreatic Adenocarcinoma

et al. 2022

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ImportanceOnly a few high-volume centers have reported on long-term oncologic outcomes after minimally invasive pancreatic surgery (MIPS) for pancreatic adenocarcinoma, but none of them have shown superior long-term overall survival (OS) compared with open pancreatic surgery (OPS).ObjectiveTo study long-term survival after MIPS and OPS with curative intent among patients with pancreatic adenocarcinoma.Design, Setting, and ParticipantsThis comparative effectiveness study used a retrospective analysis of a prospectively maintained electronic database of patient data collected between January 2010 and December 2019. Consecutive patients from a high-volume pancreatic cancer referral center were included. Data analysis was conducted from March to October 2022. Median follow-up time was 56.8 months.ExposuresPatients were matched using propensity score models to study long-term survival.Main Outcomes and MeasuresSurvival outcomes were analyzed using the Cox proportional hazards model. Variables used for propensity score correction were TNM stage, tumor dimension, lymph node status, type of operation, simultaneous vascular resection, neoadjuvant chemotherapy, adjuvant chemotherapy, sex, age, and American Society of Anesthesiologists score. Additional corrections were made for year of surgery and type of adjuvant chemotherapy.ResultsAfter propensity score matching the sample of 396 patients, there were 198 patients in the MIPS group (89 [44.9%] men; median [range] age, 68 [32-87] years) and 198 in the OPS group (94 [47.5%] men; median [range] age, 67 [39-84] years). Median OS in the MIPS group was 30.7 (95% CI, 26.2-36.8) months compared with 20.3 (95% CI, 17.6-23.5) months after OPS (hazard ratio [HR], 0.70; 95% CI, 0.56-0.87; P = .002). Median disease-free survival (DFS) after MIPS vs OPS was 14.8 (95% CI, 11.8-17.0) months vs 10.7 (95% CI, 9.0-12.1) months (HR, 0.71; 95% CI, 0.57-0.89; P = .003). Additional corrections for year of surgery and type of adjuvant chemotherapy showed better OS (year of surgery: HR, 0.74; 95% CI, 0.57-0.96; P = .02; adjuvant chemotherapy: HR, 0.71; 95% CI, 0.56-0.90; P = .005) and DFS (year of surgery: HR, 0.77; 95% CI, 0.59-0.99; P = .04; adjuvant chemotherapy: HR, 0.72; 95% CI, 0.57-0.92; P = .009) for patients undergoing minimally invasive vs open surgery.Conclusions and RelevanceIn this study of 396 patients with borderline resectable and resectable pancreatic adenocarcinoma, MIPS was associated with better OS and DFS than OPS. Centralization of MIPS should be stimulated, and pancreatic surgeons should be encouraged to pass the learning curve before implementing MIPS for pancreatic adenocarcinoma in daily clinical practice.

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“…Pancreatic cancer, a notoriously aggressive disease with complex management, has in recent years been aggregated to specialized medical centers. In this issue of JAMA Surgery , Bateni et al present a review of outcomes and cost after attempted curative resection for early-stage pancreatic adenocarcinoma. Data were obtained from the California Cancer Registry along with the Office of Statewide Hospital Planning and Development.…”

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confidence: 99%

Aggregating Pancreatic Cancer Care to Specialized Centers—A High-Value Decision?

Massoumi

Hines

2019

JAMA Surg

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In the era of skyrocketing health care costs, measuring value in the hospital setting has become crucial. Pancreatic cancer, a notoriously aggressive disease with complex management, has in recent years been aggregated to specialized medical centers. In this issue of JAMA Surgery, Bateni et al 1 present a review of outcomes and cost after attempted curative resection for early-stage pancreatic adenocarcinoma. Data were obtained from the California Cancer Registry along with the Office of Statewide Hospital Planning and Development. Consistent with previous reports, the study 1 showed that high-volume and National Cancer Institutedesignated cancer centers have superior overall survival rates. However, on multivariable analysis, they found that, given the higher cost burden at these centers, the improved outcomes do not translate into high-value care.As Bateni et al 1 mention in this study, defining value can be controversial. They opt to use the traditional definition of value as a ratio of quality (a survival rate in the fourth quintile or better) over cost (costs in the second quintile or less). This ratio implies that both survival and cost should equally contribute to the value of care. However, many physicians would argue that more weight should be given to patient survival and outcomes. This is the dilemma that the health care system faces today: how to prioritize patient well-being while also being cost conscious. It is clear that the United States is not realizing enough value for the exorbitant amount of money spent. A major contributor to this predicament is that health

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Defining Value for Pancreatic Surgery in Early-Stage Pancreatic Cancer

Cited by 28 publications

References 41 publications

Disparities in Pancreatic Cancer Treatment and Outcomes

Disparities in Pancreatic Cancer Treatment and Outcomes

Survival After Minimally Invasive vs Open Surgery for Pancreatic Adenocarcinoma

Aggregating Pancreatic Cancer Care to Specialized Centers—A High-Value Decision?

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