BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.
Bibliographical noteCopyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
- Aged, 80 and over
- Chi-Square Distribution
- Healthcare Disparities/trends
- Logistic Models
- Middle Aged
- Multivariate Analysis
- Neoplasm Staging
- Odds Ratio
- Pancreatectomy/adverse effects
- Pancreatic Neoplasms/mortality
- 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
PubMed: MeSH publication types
- Comparative Study
- Journal Article