Management of pancreatic adenocarcinoma in Ontario, Canada: a population-based study using novel case ascertainment

• Published in: Canadian Journal of Surgery Vol. 54; no. 1; pp. 54 - 60
• Main Authors: Borgida, Ayelet Eppel, MSc, Ashamalla, Shady, MD, MSc, Al-Sukhni, Wigdan, MD, Rothenmund, Heidi, MSc, Urbach, David, MD, MSc, Moore, Malcolm, MD, Cotterchio, Michelle, PhD, Gallinger, Steven, MD, MSc
• Format: Journal Article
• Language: French; English
• Published: Canada Joule Inc 01.02.2011; CMA Impact, Inc; Canadian Medical Association
• Subjects: Adenocarcinoma; Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Cancer; Care and treatment; Chemotherapy; Chemotherapy, Adjuvant; Clinical trials; Confidence Intervals; Disease Progression; Disease-Free Survival; Female; Humans; Male; Middle Aged; Neoplasm Invasiveness - pathology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Odds Ratio; Ontario; Pancreatectomy - methods; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Patient outcomes; Population Surveillance; Prognosis; Risk Assessment; Studies; Surgery; Surveys and Questionnaires; Survival Analysis; Ontario; Canada; Ontario Canada
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.026409

Background Pancreatic adenocarcinoma (PA) is largely incurable, although recent progress has been made in the safety of surgery for PA and in adjuvant and palliative chemotherapy. The purpose of this study was to describe the management of PA in Ontario, Canada. Methods The Pathology Information Management System (PIMS), which uses electronic pathology reporting (E-path), was used to rapidly identify and recruit patients based on a pathologic diagnosis of PA between 2003 and 2006. Patients were mailed questionnaires for additional data. Results The patient participation rate was 26% (351 of 1325). Nonresponders were more likely to be older than 70 years (43% v. 28%, p < 0.001) and to have received treatment in nonacademic centres (53% v. 34%, p < 0.001). Fifty-four percent of responders underwent a potentially curative operation, and most (77%) were 70 years or younger ( p = 0.03). Completed resections were documented in 83% of patients who underwent exploratory surgery with curative intent; 17% of patients had unresectable and/or metastatic disease at laparotomy. Of the completed resections, 24% were performed in nonacademic centres with a 32% positive margin rate; 76% were performed in academic centres with a 29% positive margin rate ( p = 0.84). Resections with curative intent were less frequently aborted in academic centres (10% v. 33%, p < 0.001). Of the patients who responded to our questionnaire, 43% received chemotherapy and 7% participated in clinical trials. Conclusion Despite using PIMS and E-path, the response rate for this study was low (< 30%). Nonresponders were older and more commonly treated in nonacademic centres. Patients undergoing surgery in academic centres had higher resection rates. The rate of adjuvant and palliative chemotherapy was stage-dependent and low.