Advanced pancreatic adenocarcinoma outcomes with transition from devolved to centralised care in a UK regional cancer centre

Background

Clinical trials have demonstrated modest survival and quality of life benefits for palliative chemotherapy in advanced pancreatic cancer but this is rarely translated into real-world outcomes. We hypothesised that centralisation of advanced pancreatic adenocarcinoma management could increase chemotherapy use and potentially improve survival rates. Within Merseyside and Cheshire (UK), we transitioned from devolved to centralised pancreatic cancer management during 2011-2012. We now determine the effect of such change with respect to chemotherapy use and patient outcomes.

Methods

Data were collected for all cases of advanced pancreatic adenocarcinoma reviewed through Clatterbridge Cancer Centre according to two groups; 1^st Oct 2009- 31^st Dec 2010 (Early Group, E) or 1^st Jan 2013- 31^st Mar 2014 (Late Group, L). Data collected included patient demographics, treatment received and date of death. Analysis of data included overall survival (OS) and 30-day chemotherapy mortality rates.

Results

Chemotherapy was received by 43% (n= 52/121) in Group E and 67% (n= 77/115) in Group L. Reduced time to start of treatment was seen in Group L compared with Group E (18 vs 28 days, p = 0.001). More patients received second-line chemotherapy in Group L versus Group E (23.4% vs 1.9%, p =< 0.001). Fewer patients aged >70 were treated in Group E compared to Group L (24.5% vs 57.4%, p = 

Conclusions

A centralised clinic model for advanced pancreatic cancer management resulted in higher use of chemotherapy with shorter time to treatment compared to devolved care. The increased use of chemotherapy resulted in a modest increase in OS but did not increase 30-day mortality on chemotherapy.

Clinical trial identification

N/A

Legal entity responsible for the study

Dr O Faluyi

Funding

Clatterbridge Cancer Centre

Disclosure

All authors have declared no conflicts of interest.