Geographic disparities in surgical treatment recommendation patterns and survival for pancreatic adenocarcinoma
| Autor: | Aitua Salami, Amit R.T. Joshi, Nkosi H. Alvarez |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Multivariate analysis Time Factors Adenocarcinoma 03 medical and health sciences 0302 clinical medicine Pancreatectomy Risk Factors Pancreatic cancer medicine Odds Ratio Humans Healthcare Disparities Practice Patterns Physicians' Aged Neoplasm Staging Proportional Hazards Models Retrospective Studies Aged 80 and over Univariate analysis Chi-Square Distribution Hepatology Proportional hazards model business.industry General surgery Process Assessment Health Care Gastroenterology Retrospective cohort study Odds ratio Middle Aged medicine.disease United States Pancreatic Neoplasms Logistic Models Treatment Outcome 030220 oncology & carcinogenesis Multivariate Analysis 030211 gastroenterology & hepatology Female business Chi-squared distribution SEER Program |
| Zdroj: | HPB : the official journal of the International Hepato Pancreato Biliary Association. 19(11) |
| ISSN: | 1477-2574 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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