Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancer

Morten Ladekarl; Louise Skau Rasmussen; Jakob Kirkegård; Inna Chen; Per Pfeiffer; Britta Weber; Halla Skuladottir; Kell Østerlind; Jim Stenfatt Larsen; Frank Viborg Mortensen; Henriette Engberg; Henrik Møller; Claus Wilki Fristrup

doi:10.1080/0284186X.2021.2012252

Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancer

Morten Ladekarl^*, Louise Skau Rasmussen, Jakob Kirkegård, Inna Chen, Per Pfeiffer, Britta Weber, Halla Skuladottir, Kell Østerlind, Jim Stenfatt Larsen, Frank Viborg Mortensen, Henriette Engberg, Henrik Møller, Claus Wilki Fristrup

^*Corresponding author for this work

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Abstract

Aim: Academic and high volume hospitals have better outcome for pancreatic cancer (PC) surgery, but there are no reports on oncological treatment. We aimed to determine the influence of facility types on overall survival (OS) after treatment with chemotherapy for inoperable PC. Material and methods: 2,657 patients were treated in Denmark from 2012 to 2018 and registered in the Danish Pancreatic Cancer Database. Facilities were classified as either secondary oncological units or comprehensive, tertiary referral cancer centers. Results: The average yearly number of patients seen at the four tertiary facilities was 71, and 31 at the four secondary facilities. Patients at secondary facilities were older, more frequently had severe comorbidity and lived in non-urban municipalities. As compared to combination chemotherapy, monotherapy with gemcitabine was used more often (59%) in secondary facilities than in tertiary (34%). The unadjusted median OS was 7.7 months at tertiary and 6.1 months at secondary facilities. The adjusted hazard ratio (HR) of 1.16 (confidence interval 1.07–1.27) demonstrated an excess risk of death for patients treated at secondary facilities, which disappeared when taking type of chemotherapy used into account. Hence, more use of combination chemotherapy was associated with the observed improved OS of patients treated at tertiary facilities. Declining HR’s per year of first treatment indicated improved outcomes with time, however the difference among facility types remained significant. Discussion: Equal access to modern combination chemotherapy at all facilities on a national level is essential to ensure equality in treatment results.

Original language	English
Journal	Acta Oncologica
Volume	61
Issue	3
Pages (from-to)	277-285
Number of pages	9
ISSN	0284-186X
DOIs	https://doi.org/10.1080/0284186X.2021.2012252
Publication status	Published - Mar 2022

Keywords

Chemotherapy
disparity
hospital facility
pancreas cancer
prognosis

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10.1080/0284186X.2021.2012252Licence: CC BY-NC-ND

Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancerFinal published version, 1.83 MBLicence: CC BY-NC-ND

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Ladekarl, M., Rasmussen, L. S., Kirkegård, J., Chen, I., Pfeiffer, P., Weber, B., Skuladottir, H., Østerlind, K., Larsen, J. S., Mortensen, F. V., Engberg, H., Møller, H., & Fristrup, C. W. (2022). Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancer. Acta Oncologica, 61(3), 277-285. https://doi.org/10.1080/0284186X.2021.2012252

@article{989afd48f71f4173aad734ba677573c7,

title = "Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancer",

abstract = "Aim: Academic and high volume hospitals have better outcome for pancreatic cancer (PC) surgery, but there are no reports on oncological treatment. We aimed to determine the influence of facility types on overall survival (OS) after treatment with chemotherapy for inoperable PC. Material and methods: 2,657 patients were treated in Denmark from 2012 to 2018 and registered in the Danish Pancreatic Cancer Database. Facilities were classified as either secondary oncological units or comprehensive, tertiary referral cancer centers. Results: The average yearly number of patients seen at the four tertiary facilities was 71, and 31 at the four secondary facilities. Patients at secondary facilities were older, more frequently had severe comorbidity and lived in non-urban municipalities. As compared to combination chemotherapy, monotherapy with gemcitabine was used more often (59%) in secondary facilities than in tertiary (34%). The unadjusted median OS was 7.7 months at tertiary and 6.1 months at secondary facilities. The adjusted hazard ratio (HR) of 1.16 (confidence interval 1.07–1.27) demonstrated an excess risk of death for patients treated at secondary facilities, which disappeared when taking type of chemotherapy used into account. Hence, more use of combination chemotherapy was associated with the observed improved OS of patients treated at tertiary facilities. Declining HR{\textquoteright}s per year of first treatment indicated improved outcomes with time, however the difference among facility types remained significant. Discussion: Equal access to modern combination chemotherapy at all facilities on a national level is essential to ensure equality in treatment results.",

keywords = "Chemotherapy, disparity, hospital facility, pancreas cancer, prognosis",

author = "Morten Ladekarl and Rasmussen, {Louise Skau} and Jakob Kirkeg{\aa}rd and Inna Chen and Per Pfeiffer and Britta Weber and Halla Skuladottir and Kell {\O}sterlind and Larsen, {Jim Stenfatt} and Mortensen, {Frank Viborg} and Henriette Engberg and Henrik M{\o}ller and Fristrup, {Claus Wilki}",

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.",

year = "2022",

month = mar,

doi = "10.1080/0284186X.2021.2012252",

language = "English",

volume = "61",

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Ladekarl, M, Rasmussen, LS, Kirkegård, J, Chen, I, Pfeiffer, P, Weber, B, Skuladottir, H, Østerlind, K, Larsen, JS, Mortensen, FV, Engberg, H, Møller, H & Fristrup, CW 2022, 'Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancer', Acta Oncologica, vol. 61, no. 3, pp. 277-285. https://doi.org/10.1080/0284186X.2021.2012252

Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancer. / Ladekarl, Morten; Rasmussen, Louise Skau; Kirkegård, Jakob et al.
In: Acta Oncologica, Vol. 61, No. 3, 03.2022, p. 277-285.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancer

AU - Ladekarl, Morten

AU - Rasmussen, Louise Skau

AU - Kirkegård, Jakob

AU - Chen, Inna

AU - Pfeiffer, Per

AU - Weber, Britta

AU - Skuladottir, Halla

AU - Østerlind, Kell

AU - Larsen, Jim Stenfatt

AU - Mortensen, Frank Viborg

AU - Engberg, Henriette

AU - Møller, Henrik

AU - Fristrup, Claus Wilki

PY - 2022/3

Y1 - 2022/3

N2 - Aim: Academic and high volume hospitals have better outcome for pancreatic cancer (PC) surgery, but there are no reports on oncological treatment. We aimed to determine the influence of facility types on overall survival (OS) after treatment with chemotherapy for inoperable PC. Material and methods: 2,657 patients were treated in Denmark from 2012 to 2018 and registered in the Danish Pancreatic Cancer Database. Facilities were classified as either secondary oncological units or comprehensive, tertiary referral cancer centers. Results: The average yearly number of patients seen at the four tertiary facilities was 71, and 31 at the four secondary facilities. Patients at secondary facilities were older, more frequently had severe comorbidity and lived in non-urban municipalities. As compared to combination chemotherapy, monotherapy with gemcitabine was used more often (59%) in secondary facilities than in tertiary (34%). The unadjusted median OS was 7.7 months at tertiary and 6.1 months at secondary facilities. The adjusted hazard ratio (HR) of 1.16 (confidence interval 1.07–1.27) demonstrated an excess risk of death for patients treated at secondary facilities, which disappeared when taking type of chemotherapy used into account. Hence, more use of combination chemotherapy was associated with the observed improved OS of patients treated at tertiary facilities. Declining HR’s per year of first treatment indicated improved outcomes with time, however the difference among facility types remained significant. Discussion: Equal access to modern combination chemotherapy at all facilities on a national level is essential to ensure equality in treatment results.

AB - Aim: Academic and high volume hospitals have better outcome for pancreatic cancer (PC) surgery, but there are no reports on oncological treatment. We aimed to determine the influence of facility types on overall survival (OS) after treatment with chemotherapy for inoperable PC. Material and methods: 2,657 patients were treated in Denmark from 2012 to 2018 and registered in the Danish Pancreatic Cancer Database. Facilities were classified as either secondary oncological units or comprehensive, tertiary referral cancer centers. Results: The average yearly number of patients seen at the four tertiary facilities was 71, and 31 at the four secondary facilities. Patients at secondary facilities were older, more frequently had severe comorbidity and lived in non-urban municipalities. As compared to combination chemotherapy, monotherapy with gemcitabine was used more often (59%) in secondary facilities than in tertiary (34%). The unadjusted median OS was 7.7 months at tertiary and 6.1 months at secondary facilities. The adjusted hazard ratio (HR) of 1.16 (confidence interval 1.07–1.27) demonstrated an excess risk of death for patients treated at secondary facilities, which disappeared when taking type of chemotherapy used into account. Hence, more use of combination chemotherapy was associated with the observed improved OS of patients treated at tertiary facilities. Declining HR’s per year of first treatment indicated improved outcomes with time, however the difference among facility types remained significant. Discussion: Equal access to modern combination chemotherapy at all facilities on a national level is essential to ensure equality in treatment results.

KW - Chemotherapy

KW - disparity

KW - hospital facility

KW - pancreas cancer

KW - prognosis

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U2 - 10.1080/0284186X.2021.2012252

DO - 10.1080/0284186X.2021.2012252

M3 - Journal article

C2 - 34879787

AN - SCOPUS:85121357995

SN - 0284-186X

VL - 61

SP - 277

EP - 285

JO - Acta Oncologica

JF - Acta Oncologica

IS - 3

ER -

Disparity in use of modern combination chemotherapy associated with facility type influences survival of 2655 patients with advanced pancreatic cancer

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