Receipt of Adjuvant Therapy at High-Volume Center Improves Survival in Patients With Pancreatic Cancer


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As a small, single-institution study, the findings do not warrant a change in practice. Nevertheless, pancreatic cancer patients eligible for surgical resection should consider surgery at a high-volume institution and continuing care in that setting.

Meg Mandelson, PhD, MPH

Patients with pancreatic cancer who received adjuvant chemotherapy at a high-volume center had superior median and 5-year overall survival than did patients who were treated in a community setting, according to the results of a study presented at the 2016 Gastrointestinal Cancers Symposium.1

This study sought to identify whether volume of the center is associated with superior outcomes in the adjuvant therapy setting, the authors said. Meg Mandelson, PhD, MPH, of Floyd & Delores Jones Cancer Institute at Virginia Mason, Seattle, Washington, reported the findings based on the adjuvant treatment of patients at her institution (ie, a high-volume center), compared with community settings.

Patients with cancer at Virginia Mason are seen within a multispecialty group practice of more than 400 primary and specialty physicians. Digestive system cancers comprise more than one-quarter of all cancers treated there, and patients with pancreatic cancer number about 300 per year, she said.

The study enrolled 245 patients diagnosed with pancreatic cancer between 2003 and 2014. All patients were resected at Virginia Mason and were intended to undergo adjuvant treatment either at Virginia Mason or were referred to an outside medical oncologist.

Within this group, 57% received adjuvant therapy at a high-volume center, and 43% were treated by a community oncologist. Patients treated in the community were older (68 vs 63 years; P < .01), but were similar with respect to stage, tumor size, and resection margins. Survival of the two groups was compared.

Improved Survival in High-Volume Cohort

The study found that, in this select group of patients with localized disease, those who underwent successful surgical resection and received adjuvant chemotherapy at a high-volume institution had significantly longer overall survival (44 vs 28 months; hazard ratio = 0.63; P < .01) than patients resected at the high-volume center but who received adjuvant therapy from community providers. A similar difference was observed for 5-year survival (39% vs 25%; P < .01).

Adjusting the data for the difference in age did not affect the results, Dr. Mandelson reported. Patients at the high-volume center were very likely to start chemotherapy (96%), receive a multiagent regimen (81%), and undergo chemoradiation therapy (53%), she noted.

Dr. Mandelson said the results are not surprising, since studies have shown many patients with pancreatic cancer never receive chemotherapy or receive only single-agent treatment. At high-volume centers, the standard of care tends to be multimodality therapy.

Contributing Factors

Dr. Mandelson suggested a number of factors that could contribute to the survival benefit observed in the high-volume group: patient-related factors, such as motivation and the impact of paraneoplastic conditions such as sarcopenia; tumor-related factors; and treatment-related factors, such as completion of therapy and aggressive supportive care.

High-Volume Center vs Community Setting

  • Virginia Mason researchers evaluated patients with pancreatic cancer who underwent resection there and then received adjuvant treatment at Virginia Mason (a high-volume center) or in the community.
  • Resected patients treated at the high-volume center had significantly better overall survival (44 vs 28 months; hazard ratio = 0.63; P < .01) than resected patients referred to community providers for adjuvant therapy.

“Patient volume itself may be an indicator for multidisciplinary treatment planning, experience on the part of clinicians and staff, and/or better supportive services, so that a high percentage of patients complete therapy,” she pointed out.

Finally, Dr. Mandelson acknowledged that as a small, single-institution study, the findings do not warrant a change in practice. “Nevertheless,” she said, “pancreatic cancer patients eligible for surgical resection should consider surgery at a high-volume institution and continuing care in that setting.■

Disclosure: Dr. Mandelson reported no potential conflicts of interest.

Reference

1. Mandelson MT, Picozzi VJ: Resected pancreatic cancer: Impact of adjuvant therapy at a high-volume center on overall survival. 2016 Gastrointestinal Cancers Symposium. Abstract 191. Presented January 22, 2016.



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